Parental Substance Use and Foster Care Reentry

Foster care involvement due to parental substance use is a common problem with many challenges associated with service delivery. Using administrative data from a Midwestern state between the years 2009 and 2015 (N = 17,420), this study examines characteristics of substance-abusing families at the time of entry into the foster care system and estimates the risk of reentry subsequent to reunification. Bivariate findings and survival analysis for reentry suggests substance-using parents are more likely to be involved in additional allegations associated with foster care involvement. These results highlight the need for improved services integration and coordinated delivery among service systems.     

Understanding reentry to out-of-home care for reunified infants

Although many children placed in out-of-home care are reunified with their families of origin, a significant portion reenter care, reflecting continued family problems and weaknesses within the child welfare system. For infants, the stability of reunification is particularly crucial, given their developmental stage. This study reviewed the case records of 88 randomly selected infants who had been reunified with their families. Thirty-two percent of those infants reentered care within four to six years of their reunification. The identification of factors predictive of reentry into care has both policy and practice implications.     

Finnish children in foster care: evaluating the breakdown of long-term placements.

Save the Children studied risk factors associated with placement disruption or breakdown in cases where long-term foster care was intended. Before their placement in 180 foster families, most of the 234 children studied (75%) had experienced neglect. The followup time after initial placement averaged four years and two months. Achieving long-term beneficial foster care placement of children of varied ages and experiences with abuse and neglect, involved considering the needs of the foster parents who may or may not have their own children or other children in their care. Some children were reunified with their parents; careful evaluation is needed before such reunion.     

Foster home licensing and risk of reentry to out-of-home care following family reunification

Family reunification without subsequent reentry is the primary permanency goal for children placed in foster care. While a number of placement-level factors have been examined for their effect on subsequent reentry to care, no study to date has considered foster care licensing. The current study uses statewide administrative data to construct a cohort of foster care youth who entered care between 2009 and 2012 and were reunified by the start of 2013 (N = 7752) to investigate the association between types of foster care and the probability of reentry to foster care up to two years following reunification. We focus specifically on the licensing status of foster homes, and employ propensity score analysis to address selection bias in placement type. A propensity-weighted cox proportional hazard model revealed that youth placed in licensed relative care (LRC) homes and licensed non-relative care (LNC) homes were more likely to reenter foster care than those youth placed in unlicensed relative care (URC) homes during their first spell of foster care.     

Intergenerational families in child welfare: Assessing needs and estimating permanency

Much of the empirical literature on intergenerational child maltreatment focuses on the mechanisms that explain how maltreatment is transmitted across generations. Few studies have examined child protective service outcomes associated with intergenerational families. The current study addresses this gap in the literature. This study compares 1196 caregivers, most of whom are single African American females, and 2143 children from first and second generation child welfare-involved families. All families have a history of substance abuse. We sought to understand how first and second generation families differ with regard to social and economic status indicators, as well as whether intergenerational child welfare involvement is associated with permanency outcomes. Our findings indicate that second generation families experience significantly more risk factors at the time of case opening, and are two-thirds as likely to be reunified as compared with first generation families. The singular effects of generation status disappeared, however, once the interaction between mental health diagnosis and second generation status was entered into the model, suggesting that it is not just being intergenerationally involved in the child welfare system that reduces the chance of reunification, but rather second generation caregivers have more mental health problems that are associated with a lower likelihood of reunification.     

Predictors of reentry into the foster care system: Comparison of children with and without previous removal experience

Foster care reunification is the most common permanency plan for children in care, but it can be a challenging and stressful process for both the child and birth family. In some cases, the family reunification is unsuccessful and requires removal of the child from the home and reentry into care. The current study focuses on two groups: children who have had no previous removal-foster care experience and those who have had previous removal experience. The aims of the present study are to: (1) examine the rate of reentry for children who have no previous removal-foster care experience versus those who have previous removal experience prior to the current episode; (2) measure the period between the time of the reunification and the time of reentry to care for both groups; and (3) identify risk and protective factors correlated with reentry for both groups. The study analyzes secondary data through survival analysis. The sample includes 4642 children exiting from care to reunification between 2010 and 2013, who are followed for 18 months. The rate of reentry for children with previous removal experience was much higher (25% vs. 16%), and the time of highest risk for future reentry was shorter (4 vs. 6 months, after reunification) compared to children without removal experience. Several common risk factors were found for both groups. Child behavior, reunification against agency recommendation, and siblings in care increased the odds of reentry. However, visitation of the family by a case worker post-reunification decreased the risk for reentry. Child welfare administrators and caseworkers should continue to work toward providing care and ensuring that the child and family are fully prepared for reunification. Programs and post reunification services must be targeted and provided to children with previous removal experience.     

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.     

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.     

Comparing the health status of low-income children in and out of foster care

Children in foster care face poverty, family dysfunction, neglect, and abuse, with high rates of chronic health, emotional, and developmental problems. This study compared the overall health status of a group of children entering foster care with a group of Medicaid-eligible children living with their parents, matched for age and gender. It identified significantly more health and developmental problems in children in foster care than in the comparison group. Possible contributors to the higher percentage of problems among foster care children may be that the foster children have more problems related to the underlying risk factors resulting in placement, or that the foster care physicians conducted a more comprehensive assessment or had lower clinical thresholds. Further research is necessary to identify and treat the problems of this high-risk group.     

Reunification of foster children: Factors associated with reunification outcomes in Flanders and the Netherlands

Although a significant number of foster children eventually return to their birth parents, evidence-based models for permanency planning are scarce, and there is a lack of clear decision-making criteria for reunification. This study aimed to establish further knowledge about reunification. Both reunification pace and factors which are associated with reunification were examined. The focus was on factors related to the foster child, the birth parents, the foster parents and the foster placement, and reasons for removal. Case file analysis was performed for 580 Flemish and Dutch foster children ages 0–18. Cox regression analyses showed contact with birth parents to be most strongly associated with reunification. Moreover, particularly placement related factors (e.g., legal framework, additional support services, contact with birth parents) increased the likelihood of reunification. Furthermore, over a period of six years approximately 15% of foster placements led to reunification notably during the first 2.5 years of placement. Policy makers and foster care professionals are therefore encouraged to timely aim for permanency planning. Reunification efforts should be planned from the start of the foster placement. If subsequently reunification proves not feasible, permanency should be secured within the foster family.     

The disparate impact of alcohol,methamphetamine, and other drugs on family reunification

Parental substance abuse is one of the most prominent reasons that children enter foster care. The relative role of substance type in delaying reunification has remained elusive. This study sought to understand the impact of parental use of alcohol, methamphetamine, other drugs, and poly-substances on reunification rates for children in foster care. The authors used administrative foster care data from a Midwestern state between years 2007 and 2012 to evaluate the unique contribution of each substance use domain. Results suggest that parental methamphetamine use has the most significant impact on the likelihood of reunification, followed by other drugs, and poly-substances. These findings further indicate that children removed due to any parental drug use stay in foster care for an average of 49–156 days longer than their peers. Implications for research and practice are addressed.     

Substance use in youth adopted from foster care: Developmental mechanisms of risk

Children who enter foster care are at unique risk for developing substance abuse due to experiencing early life stressors. A large body of research has revealed robust effects of various stressors on later substance use, implicating the role of early neurobiological changes that create chronic internalizing problems. However, less literature has investigated externalizing behavior as a mechanism underlying this relationship. Moreover, few studies have examined these mechanisms through a model of cumulative risk. The present study examined whether the prospective association between cumulative pre-adoptive risk (e.g., maltreatment, age at placement, foster placement instability, ever having lived with birth parent) and adolescent/young-adult substance use was mediated by childhood internalizing and externalizing problems in youth adopted from foster care. Participants included 82 adoptees, most with histories of prenatal substance exposure (72%). We tested parent-rated internalizing and externalizing problems across 5 years in childhood as simultaneous mediators of cumulative risk and level of substance use 11–15 years later. Bootstrapping mediation procedures, controlling for age, prenatal substance exposure, adolescent/young adult mental health symptomatology, and youth participation in follow-up, revealed a significant indirect effect of cumulative risk on substance use through childhood internalizing problems, but not externalizing problems. These results underline the importance of mitigating early risk for children in the child welfare system and call for targeting childhood emotion dysregulation to reduce likelihood of substance abuse among previously high-risk adoptees. Nevertheless, low rates of substance use overall in the present sample underscore the positive impact of adoptive placement on mitigating risk for substance abuse among foster youth.     

Correlates of the Randolph Attachment Disorder Questionnaire (RADQ) in a Sample of Children in Foster Placement

This study examined mental health and attachment problems in children in foster care. This study also obtained data concerning the validity of the Randolph Attachment Disorder Questionnaire (RADQ). Children were selected according to length of time in placement and age and screened for mental health symptoms using the Child Behavior Checklist and the RADQ. The findings showed that children in foster care have reported symptoms within the range typical of children not involved in foster care. The conclusion is that the RADQ has limited usefulness due to its lack of specificity with implications for treatment of children in foster care.     

Mental health service utilization in children adopted from US foster care,US private agencies and foreign countries: Data from the 2007 National Survey of Adoption Parents (NSAP)

Aims

In this analysis, we (1) described the rate of mental health service utilization for children from domestic foster care adoption, domestic private adoption, and international adoption and (2) analyzed the effect of common risk factors on mental health service utilization.

Data

As part of the 2007 National Survey on Adoptive Parents (NSAP), parents with children 5–17 years old (N = 1722) were asked if their children had received mental health services and how helpful these services were. Parents also provided data on the children's demographics and likelihood of pre-adoption adversity (e.g., abuse).

Results

For boys, mental health services were utilized by 52.4% of domestic foster care adoptees, 41.0% domestic private adoptees, and 40.0% of international adoptees. For girls, the corresponding rates were 36.3%, 24.8%, and 30.9% respectively. Parents reported that the services were very helpful for about half of the children. Logistic regression analyses showed that adoptees from domestic foster care were more likely than international adoptees to have received mental health services, but there was no difference between domestic private adoptees and international adoptees. Older age at placement, older age at assessment, having special health care needs, and being male all increased the odds for having received mental health services.     

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.     

Why do children placed out-of-home because of parental substance abuse have less mental health problems than children placed for other reasons?

The purpose of this paper was to compare children placed out-of-home because of parental substance abuse (PSA) with children placed for other reasons (NPSA), and to explore the association between PSA and mental health problems in a Norwegian sample of 6- to 12-year-old children in out-of-home care (N = 109). Several group differences were found related to the children themselves, their families and the Child Welfare case. The PSA children had less total difficulties, conduct problems and emotional problems than the NPSA children assessed by the teachers on the Revised Rutter Scale. However, both groups had far more mental health problems than children in general. The most important variable explaining the group difference in all subgroups of mental health problems was the extent of prosocial behavior in the children, but being placed for behavioral problems also explained a significant part of total difficulties and conduct problems. Variables like gender, discipline problems and socioeconomic conditions did not have a significant effect. The conclusion of the study was that prosocial behavior might be regarded as an important protective factor against mental health problems, which is an argument for investing in programs focusing on enhancing the placed children's mastering strategies.     

Alcohol and drug abuse among young adults who grew up in substitute care — Findings from a Swedish national cohort study

To what extent substitute long term care modifies intergenerational transmission of substance abuse has rarely been investigated. Using register data, we followed a national cohort born 1973–1985 consisting of 1012 national adoptees, 2408 former children from long term foster care, 348/846 environmental siblings of adoptees/foster children, and 952,935 majority population peers, from their 15th birthday to age 27–35. Using Cox regression, we calculated hazard ratios (HR) for hospital care and criminality associated with illicit drug/alcohol abuse, with adjustments for socio-demographic indicators of caring families, and substance abuse in caring and birth parents.     

Reunification outcomes among Mexican immigrant families in the child welfare system

This study examined reunification outcomes among Mexican immigrant families involved in the child welfare system, and compared characteristics of Mexican-origin and non-immigrant children involved in the child welfare system. An exploratory retrospective longitudinal design using administrative data from two counties in Northern California was utilized. The quantitative sample (N = 2152) included children entering the foster care system for 8 or more days between January 1, 2001 and December 31, 2007 in the two participating counties. Child welfare administrative data (CWS/CMS) were merged with eligibility data (CalWIN) in order to obtain parent and child place of birth and citizenship status. Quantitative measures drawn from the merged CWS/CMS and CalWIN dataset included the following: demographic characteristics, immigrant characteristics, case characteristics and reunification outcomes. Results indicated that a significantly higher proportion of Mexican immigrant families (70.7%) were reunified than non-immigrant families (43.1%). Significant correlates of reunification among Mexican immigrant families included the following: mothers with authorized citizenship status (vs. unauthorized citizenship status), mothers whose primary language was Spanish (vs. English), and children with two or fewer placements (vs. three or more placements). Differences between Mexican-origin and non-immigrant children were that Mexican-origin children were older on average than non-immigrant children, and they were more likely to experience physical abuse, sexual abuse or emotional abuse; they were also more likely to be placed in foster care or a group home (vs. relative care). Implications for social work practice and policy 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.     

Recovery coaches and the stability of reunification for substance abusing families in child welfare

Substance abuse is a long-standing challenge for child welfare systems. Parental substance abuse disrupts family stability, family cohesion, and jeopardizes the well-being of children. In the current study we test an intervention to improve child welfare outcomes for substance abusing families, specifically the probability of families achieving a stable (at least 12 months) reunification. The intervention was an integrated case management model where recovery coaches were appointed to substance abusing parents associated with an open foster care placement. A diverse group of families (n = 1623) were randomly assigned to either a control group (services as usual) or an experimental group (services as usual plus a recovery coach). Multinomial logistic regression indicated that substance abusing parents associated with a recovery coach were significantly more likely to achieve a stable reunification as compared with similar families in the control group.