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.     

“I want to be there when he graduates:” Foster parents show higher levels of commitment than group care providers

Group care is a frequent placement for adolescents placed in out of home care when their birth parents' care is deemed unsafe. In the present study, we assessed whether foster parents show greater commitment to children than group care providers. Given that group care represents a number of living arrangements, we considered both shift care (where staff work shifts and do not live with the children) and cottage care (where staff live for extended periods of time with the children in a group living context). Commitment was assessed using the This Is My Child Interview (adapted for adolescents). Thirty-one foster parents, 18 shift workers, and 28 cottage care providers were interviewed. As predicted, foster parents showed higher levels of commitment than both shift care workers and cottage care providers, and the associations held when children's externalizing behaviors and the number of children the caregivers had cared for were controlled. The results suggest that foster care promotes greater commitment among caregivers than other out of home placements, and add to other findings that favor foster care as the out of home placement of choice for adolescents.     

Crisis nursery effects on child placement after foster care

The results of a study of the relationship between receiving crisis nursery services and the placement outcomes for young children leaving the child welfare system in Illinois are reported in this paper. The placement outcomes for children leaving foster care whose families received crisis nursery support prior to the children's placement in foster care is compared to the placement outcomes for children whose families received only foster care services. The children in two samples were identified by matching crisis nursery children's data from FY 2006 with children's data in the Illinois Child Abuse and Neglect Tracking System and Children Youth and Services Information System databases. After children served by crisis nursery and foster care services were identified, a comparison group of children with like-characteristics whose families received only foster care services was identified using propensity score matching. The children were followed until their out-of-home placement was terminated or until June 30, 2009. The placement outcomes and the length of stay were compared for the two groups. Using logistical regression analysis the results showed that children whose families received crisis nursery services prior to foster care placement were twice as likely to be reunited with their biological families (birth or extended family members) when compared to children whose families received only foster care services. The difference in the length-of-stay in foster care was not statistically significant when the two groups were compared. This preliminary study using administrative data shows that receiving crisis nursery services may have positive effects on the children's ultimate placement outcome after foster care. Additional research is needed to further explore the relationship between placement outcome and crisis nursery services.     

Compliance and Internalization in Preschool Foster Children

Child compliance and internalization are socio-cognitive developmental processes which are critical for children's social outcomes in multiple arenas. These developmental processes are found to be compromised in maltreated children. The current study was designed to add to the extremely limited literature on compliance and internalization in maltreated children in foster care. Compliance and internalization tasks were administered to preschool foster children, videotaped and later coded. Through parent-report questionnaires completed by the foster parents and observations of the foster home, the relation of compliance/internalization to child behavior problems, foster care experiences, and the foster home environment was examined. Findings revealed that most children showed committed compliance, but over 50% of children exhibited “deviation” behaviors in the internalization task. HOME acceptance scores (via observation of parent and child in home setting) significantly contributed to children's compliance levels but did not significantly contribute to their internalization. Internalization was related to children's externalizing behavior problems. These findings are considered in the context of future research and practice with respect to young children in foster care.     

The association between perception of relationship with caregivers and behaviours of youth in foster care: a child and caregiver perspective

The transition into foster care can be difficult for children. Research has consistently shown an increased risk for children in foster care to exhibit higher levels of problem behaviours in comparison to youth in the general population. The purpose of this study was to analyse the associations between the youths' perception of their relationship with their caregiver on their perception of their own internalizing and externalizing behaviours as well as the youths' perception of the relationships with caregivers and how caregivers report of youths' internalizing and externalizing behaviours. This study utilized the secondary data from the general release version of the National Survey of Child and Adolescent Well-Being [National Survey of Child and Adolescent Well-Being (2009) Introduction to the wave 1 general and restricted use releases, Nation Data Archive on Child Abuse and Neglect, Ithaca, NY]. Significant relationships between youths' perception of relationship with their caregiver were found with both youth perception of internalizing behaviours and caregiver perception of internalizing and externalizing behaviours. Results are explained with implications for practice, training, research and policy.     

Developmental outcomes after five years for foster children returned home, remaining in care, or adopted

A substantial proportion of children who enter foster care in the US are infants or toddlers and will exit from foster care before they have been in care for long, either returning home or to adoption. These first years of involvement may predict a significant amount about children's longer term development so understanding developmental outcomes after five years is valuable to understanding if child welfare services (CWS) are serving the intention of promoting the well-being of children. A subsample of 353 infants (less than 13 months of age when investigated by CWS) and subsequently placed into foster care were selected from the National Survey of Child and Adolescent Well-Being. After 66 months, these infants had been reunified, adopted, or were still in foster care. Bivariate comparisons were completed. Statistical controls for maltreatment type and severity, demographic traits, and current caregiver education were implemented to help clarify the role of terminal child welfare placement, current caregiver behaviors, and household income, on eight linear regression models of developmental outcomes. Results support the longstanding tenet of child welfare services policy that remaining in foster care is less developmentally advantageous than having a more permanent arrangement of return home or adoption.     

Compulsory residential care: An examination of treatment improvement of individual and family functioning

The aim of the present study was to examine the treatment progress of both adolescent's and their families' functioning in a new compulsory residential treatment program. The sample consisted of 339 admitted adolescents (56.3% boys). The mean age at time of entry was 15.69 (SD = 1.30). Adolescents stayed on average 9.42 months (SD = 4.66) in a new residential treatment program. Data on adolescents' internalizing and externalizing problems were assessed using self-reports, parent reports, and group care worker reports. In addition, adolescents reported their substance use and delinquency and parents also reported family functioning and level of perceived parental stress. The findings revealed a significant decrease in adolescents' self-reported internalizing and externalizing problems, delinquency, and substance use. According to parent ratings, a significant improvement was found concerning adolescents' problem behaviors during treatment. However, according care worker ratings, adolescents showed no improvement on internalizing problems and showed an increase in externalizing problems. Concerning families, although there was no improvement in family functioning, parental stress significantly improved over time. Further research should examine whether improvements experienced during treatment are maintained after treatment.     

Directions for developmental screening in child welfare based on the ages and stages questionnaires

Many young children investigated for maltreatment have developmental problems qualifying them for early intervention services, yet only a portion of these children receive such services. To address this gap, all children ages 0-3 with child welfare (CW) substantiated maltreatment in Pennsylvania are screened for developmental and socioemotional problems using the Ages and Stages Questionnaires (ASQ). This study views screening results for over 500 children to address whether children's substantiation status, living situation, and administering worker as CW or early intervention (EI) predicts screening rates. Bivariate and logistic regression analyses were used. Results showed that 22% of children scored in the problem-range of at least one developmental area and 18% scored in the problem-range of social-emotional concerns warranting EI referral. Results of bivariate analyses showed that children who spent time in the NICU were more likely to have developmental concerns. Socioemotional concerns were related to child race, foster care living situation, child as the subject of the referral, and physical neglect. Older children and children whose referral involved lacking basic needs showed both developmental and socioemotional concerns. There were no significant differences in screening results of children with substantiated versus unsubstantiated maltreatment. Children whose screening was conducted by EI were more than three times as likely to show developmental concerns compared with those screened by CW. Child welfare workers need more support when conducting developmental screening, and policies that limit screening to children with substantiated maltreatment or to children in out-of-home care should be reconsidered.     

The rich and exacting role of the social worker in family foster care

This article is about the role of the professional social worker in a child placing agency. It emphasizes the worker's central role in coordinating or managing the various facets of family foster care.Many aspects of family foster care are discussed, with emphasis upon permanence and the tasks of the social worker with the respective participants. The article briefly examines these activities, such as working with the child, the birth parents and the foster parents, within the contexts of the primary mission which is to restore family relationships or to help the child to find and build new ones.Mr. Terpstra is employed by the U.S. Children's Bureau where he serves as a specialist in family foster care, child care insittutions and licensing of children's services.     

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.     

Critical factors of intensive family work connected with positive outcomes for child welfare clients

Mechanisms producing positive change in troubled families were analysed. The study aimed to answer the questions: What kind of case and client outcomes does intensive family work (IFW) produce for child welfare clients? From the perspective of family workers, what kind of critical factors for positive child, parent and family outcomes can be identified? The study used child welfare case files of 35 families with 93 children from one social office and interviews with 20 family workers and IFW managers in 5 municipalities in Finland. The shades of worries scale was used in evaluating the change in each family's situation. The case outcome measures for children included changes in the child's status in open care, short-term placement or foster care. During IFW, positive changes took place in 23 families out of 35 (66%). Twenty-seven children from 16 families did not continue as child welfare clients. Eleven children were placed into foster care during IFW and two years after it. The critical processes for outcomes included time, trust building and engagement, practical help, facilitating communication and guaranteeing the best interest of the child. IFW was considered effective for positive outcomes for the majority of families with complex needs.     

Psychiatric Rehospitalization of Children and Adolescents: Implications for Social Work Intervention

This study explored factors associated with the psychiatric rehospitalization of children and adolescents. A retrospective archival review was conducted on 403 children and adolescents admitted into an inpatient psychiatric hospital. Results indicated that 16% were readmitted in the same year. Children and adolescents who had a prior history of psychiatric rehospitalization, lived in a residential treatment facility, and had a diagnosis of oppositional/defiant or conduct disorder were more likely to be rehospitalized. Psychosocial factors must be considered in predicting and preventing psychiatric rehospitalization. Clinical social workers should include therapeutic foster care as an option for aftercare placements of youth exhibiting externalizing behaviors and/or with a history of multiple restrictive care placements.     

Caregiver–Adolescent Dyadic Disagreement and Problem Behaviors of Adolescents in the Child Welfare System

Parents and adolescents often provide different ratings of youths' behavior problems, yet few studies have examined such disagreement and its effect on later adjustment, especially among at‐risk adolescents. The purpose of this study was to investigate, among a sample of adolescents in foster care, whether the degree of caregiver–adolescent disagreement on adolescents' internalizing problems would be associated with adolescent externalizing problem behaviors over time. Two measures of adolescent caregiver agreement, the Pearson's r and intraclass correlations, were used with data drawn from a nationally representative study of children on foster care. Growth curve analyses of 180 adolescents revealed that the higher adolescent and caregiver agreement on adolescents' internalizing problems at Wave I, the slower the increase in externalizing problems over time.     

Placement stability in non-kinship foster care: variables associated with placement disruption

In Spain research has been conducted into the outcomes of foster care, although there is a need for further analysis, especially as regards the variables associated with placement disruption. In 2008 (T1) was collated information on all foster placements that were registered in three Spanish provinces. In 2014 (T2), data were gathered by reviewing the children's case notes and through interviews with the social worker responsible for each case. The resulting sample comprised 104 non-kinship foster children in long-term foster care who were being fostered in 86 families. The results obtained at T2 showed that the percentage of children who were still living with the same family (68.3%) was greater than the proportion of children whose circumstances had changed (31.7%). The social workers considered that placement disruption had occurred in 27 of the 33 cases. One of the main finding was placement disruption was associated with the older age at the time of being fostered and the emotional relationship quality between children and foster carers. A regression analysis showed that low levels of warmth and communication in the relationship between child and foster carers were shown to be a predictor of placement breakdown. Implications for practice are discussed.     

Children's Appraisals of their Experiences in Out-of-Home Care

Few studies have asked children directly about their experiences in out-of-home care. This study uses data collected from 180 nine- to-11-year-old children currently in out-of-home care who were asked about their perceptions and appraisals of out-of-home care. Analysis of variance and chi-square analyses were used to examine whether children's appraisals of their lives following removal from their families of origin differ as a function of age, gender, race/ethnicity, type and severity of maltreatment, length of time in out-of-home care, placement type, attachment to current caregivers, and rating of current caregiver/home. Youth who were sexually and emotionally abused, youth who were satisfied with their current caregivers and placements, and girls were more likely to state that their lives would have been worse had they remained with their families of origin. Youth who were physically abused were more likely to report that their lives would have remained the same. Children living in group care were more likely than those living in family foster care or with kin to report that their lives would have been better had they remained with their families of origin. Differences were not found between children living in family foster care and those living with kin nor did children's appraisals differ based on age, race, ethnicity, length of time in out-of-home care, neglect, or severity of maltreatment.     

A preliminary evaluation: Demographic and clinical profiles and changes in functioning in children receiving psychosocial rehabilitation

The present study is the first to examine the demographic and clinical profiles at intake of children, ages 4 to 18 years, who received Child Psychosocial Rehabilitation (CSPR), a relatively new community-based treatment model for children with emotional disturbance. In addition, the relationship between the relative change in psychosocial, emotional, and behavioral functioning as measured by CAFAS (Hodges, 1989, 1994, 2000) and PECFAS (1994, 2000) scores and the children's age, gender, ethnicity, current living arrangement, internalizing and externalizing behaviors, and severity of impairment at intake were evaluated. Fifty-three children received CPSR for a minimum of six months from a for-profit outpatient child and adolescent mental health clinic located in southwestern Idaho. Significant improvement in the children's overall functioning was found after six months of treatment. Middle or high school age children demonstrated significantly more impairment at intake compared with their younger counterparts. No significant differences in overall functioning were revealed considering the characteristic of gender, living arrangement and clinical profiles at intake.     

Predictors of foster care exits to permanency: A competing risks analysis of reunification, guardianship, and adoption

Although foster care is intended to be temporary, and policy explicitly requires permanency outcomes, many children experience lengthy stays and exit foster care without a permanent family. This study sought to identify which child and placement characteristics were important predictors of exit to three types of permanency outcomes: reunification, guardianship, and adoption. A sample of 3351 children who entered foster care in 2006 was observed for 30 to 42 months. Permanency outcomes were analyzed using competing risks survival analysis. Children exited foster care to different types of permanency at different rates and frequencies. Reunification occurred most quickly and frequently. Guardianship was second in terms of median duration but third in frequency. Adoption was the second most common exit but had the longest median duration. One in four children remained in foster care or exited without permanency. While patterns varied by type of permanency, three major categories of important predictors were identified: 1) demographic characteristics of age at entry and race, 2) clinical needs related to children's disabilities and mental health problems, and 3) continuity and connections represented by kin placements, sibling placements, early stability, and absence of runaway events. Implications for practice, policy, and research are discussed.     

Child Protection Workers’ Perceptions of Foster Carers and the Foster Care System: A Study in Queensland

Abstract

Child protection workers are key players in the statutory system for the protection of children and young people. For this reason, their perceptions of the operation of the system are important. This study, conducted in Queensland, Australia, explored the views of child protection workers regarding foster carers and the foster care system. The present study revealed the difficulties the child protection workers encountered in engaging with foster carers. These difficulties were due to the structure of the child protection system and the conflicts experienced by workers in balancing the needs of children and young people, their primary clients and the carers of those children and young people. Several recommendations for policy and practice are made.     

Aggressive behaviors among Korean children in out-of-home care: The role of placement characteristics

Using data from the Korean Panel Study on Children in Out-of-Home Care, this study examined the impact of placement characteristics on aggressive behaviors among children in out-of-home care by placement type. The sample was divided into three groups based on placement type: institutional care (n = 118), group homes (n = 95), and foster care (n = 212). Results from hierarchical multiple regression analyses indicated that the length of stay in out-of-home care significantly influenced aggressive behaviors amongst children in institutional care, such that increased duration of out-of-home care decreased the level of aggressive behaviors. Perceptions of stigma/discrimination also significantly influenced aggressive behaviors displayed by children in institutional and foster care. Children with a higher perception of stigma/discrimination were more likely to exhibit severe aggressive behaviors than were their counterparts. On the other hand, placement characteristics had no significant influence on aggressive behaviors of children in group homes. The study findings suggest that children's mental health problems and disabilities should be considered during the placement procedure and interventions focusing on decreasing stigmatization should be developed and provided for children in out-of-home care.     

Exploring Gender Differences on Internalizing and Externalizing Behavior Among Maltreated Youth: Implications for Social Work Action

This purpose of this study was to explore the moderating influence of gender on the relationship between child maltreatment and internalizing symptoms (e.g., affective and somatic problems) and externalizing behavior (e.g., rule breaking behavior and aggression) among children aged 7–12 years old. Using a longitudinal comparison group design and a sample of 300 youth of which 56% (n = 168) had substantiated cases of child maltreatment, results of a structural equation modeling revealed that internalizing symptoms exerted a mediating influence that was conditioned by gender. Only girls’ internalizing symptoms were found to mediate the link between child maltreatment and externalizing behavior while a direct relationship between maltreatment and externalizing behavior was found among boys. These findings provide evidence for gender differences in the pathways between being child maltreatment and maladaptive thoughts, feelings, and behaviors. Thus, adapting evidence-based strategies that target gender specific internalizing behaviors and externalizing behaviors among maltreated youth may significantly reduce the risk of short and long-term maladaptive behavior.