How different are their experiences and outcomes? Comparing aged out and other child welfare involved youth

This paper adds to the growing body of research examining the experiences of youth aging out of the child welfare system. Through a comparison of youth aging out with two other groups of child welfare-involved youth—those whose families received child welfare services but were never placed out of home and those who were in out-of-home placement but did not age out—it presents a profile of their care careers and other system involvement (e.g., mental health, justice system). Analyses indicate that young people aging out of care have experienced significant amounts of time in out-of-home placement, a great deal of placement instability, and high levels of other system involvement. In general, their involvement is more extensive than that of the two comparison groups. However, the justice system involvement of youth who experienced out-of-home placement but did not age out is just as high as that of youth who have aged out. This finding highlights the importance of devoting resources not only to youth aging out of care but also to similarly-aged young people with prior child welfare involvement.     

Effects of Medicaid managed care policies on mental health service use among a national probability sample of children in the child welfare system

Children in the child welfare system are dependent upon Medicaid to finance services for their considerable mental health needs. This study examines the effects of Medicaid policies on mental health service use among a national probability sample of children in the child welfare system. Data for this study came from the National Survey of Child and Adolescent Well-Being, the Caring for Children in Child Welfare study, and the Area Resource File. Weighted multivariate logistic regression analyses were conducted to estimate effects of policy variables on children's use of mental health services, controlling for child-level covariates and county-level health resources. Children in counties with behavioral carve-outs under Medicaid managed care had lower odds of inpatient mental health service use. Medicaid managed care enrollment and variations in type of provider reimbursement did not affect use of mental health services. Older age, greater need for mental health services, and higher levels of caregiver education were associated with increased odds of service use. Restrictions on use of inpatient mental healthcare caused by behavioral carve-outs may disproportionately affect children in the child welfare system who have high rates of such use. Careful adoption of carve-outs is necessary to assure appropriate care for these children.     

Baseline Characteristics of Dependent Youth Who Have Been Commercially Sexually Exploited: Findings From a Specialized Treatment Program

ABSTRACT

Commercial sexual exploitation of children has emerged as a critical issue within child welfare, but little is currently known about this population or effective treatment approaches to address their unique needs. Children in foster care and runaways are reported to be vulnerable to exploitation because they frequently have unmet needs for family relationships, and they have had inadequate supervision and histories of trauma of which traffickers take advantage. The current article presents data on the demographic characteristics, trauma history, mental and behavioral health needs, physical health needs, and strengths collected on a sample of 87 commercially sexually exploited youth. These youth were served in a specialized treatment program in Miami-Dade County, Florida, for exploited youth involved with the child welfare system. Findings revealed that the youth in this study have high rates of previous sexual abuse (86% of the youth) and other traumatic experiences prior to their exploitation. Youth also exhibited considerable mental and behavioral health needs. Given that few programs emphasize the unique needs of children who have been sexually exploited, recommendations are offered for providing a continuum of specialized housing and treatment services to meet the needs of sexually exploited youth, based on the authors’ experiences working with this population.     

The effects of adoption openness and type on the mental health,delinquency, and family relationships of adopted youth

ABSTRACT

Analyzing the 2007 National Survey of Adoptive Parents, this study examines the impact of open adoption, demographics, and other factors on adopted children’s mental health, delinquent behavior, and family relationships. Specifically, we compare findings for youth in private and public (i.e., foster care) adoptions and identify key similarities and differences between predictors of children’s well-being across these two types of adoption. We find that youth in open foster care adoptions are more likely to receive an attachment disorder diagnosis than those in closed foster care adoptions but are also more likely to have family relationships characterized by trust and adoptive parents’ willingness to recommend adoption to others. Further, we find children in both public and private adoptions who are older at placement are more likely to have posttraumatic stress disorder diagnoses. For children in private adoptions, no statistically significant predictors affected youths’ delinquency outcomes or family relationships, with the exception of parents of private adoptees in households characterized by lower levels of poverty indicating they would be more likely to recommend adoption to others. The implications of the key findings are discussed with regard to service provision for multiple types of adoptive families.     

Understanding dissociation in relation to child trauma,mental health needs,and intensity of services in child welfare: A possible missing link

Abstract

While there is limited research on the role of dissociation among children and adolescents, emerging evidence links child trauma history, dissociation, risk behaviors, and other negative outcomes among youth. This study examined dissociation in relation to mental health needs and intensity of services among a large sample of youth in Illinois child welfare, upon entry into care and in residential treatment settings. The Child and Adolescent Needs and Strengths (CANS), a comprehensive, trauma-informed assessment strategy and information integration/planning tool was the primary measure. This study included two overall samples of child welfare-involved youth, ages 3–18: at entry into care (N?=?27,737) and in residential treatment (N?=?5,758). Findings indicated that rates of clinically significant dissociation were generally highest among younger youth (under age 14) and among youth with more cumulative and severe trauma. Dissociative youth were significantly more likely to exhibit several risk behaviors (e.g., fire setting and self-harm) and mental health symptoms (e.g., psychosis and somatization). Those youth with significant dissociation at entry into care were more likely to be psychiatrically hospitalized, placed into residential treatment, with greater likelihood of placement disruptions within the 2 years following entry into care. Implications of these findings are discussed in terms of the value of identifying and assessing dissociation and other trauma-related symptoms that may be less recognized but can be linked to high-risk behaviors and other negative outcomes within child welfare and across child-serving systems. Understanding dissociation may be an important component of training, service/treatment planning, and clinical care within child-serving systems.     

The journey to adopt a child who has special needs: Parents' perspectives

Many of the children eligible for adoption from the public child welfare system are considered to have special needs. Given the importance of securing adoptive families for these children, knowing more about the adoption process as it is experienced by prospective parents who complete (or are in the process of completing) their adoption pursuit and those who discontinue it are critical. Using qualitative inquiry, prospective adoptive parents in nine families were studied in an effort to learn more about their motivations, expectations, preparation, and experiences. Although the adoption outcome (continued versus discontinued) was different, the process, including negative experiences, was quite similar. Programming implications and suggestions for future research are offered.     

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.     

From Foster Care to Adoption and Guardianship: A Twenty-First Century Challenge

For nearly four decades, child welfare policy and practice have focused on the achievement of legal permanence for children in foster care. Although federal child welfare policy has resulted in the movement of children from state custody to legally permanent adoptive or guardianship families, little is known about the quality and enduring nature of these placements. A significant challenge of the twenty-first century child welfare system is how to ensure the well-being of children currently living with adoptive parents or guardians. This paper discusses child welfare policy and trends related to post-permanency well-being, including the decrease in Title IV-E foster care caseloads nationwide and the simultaneous increase in Title IV-E adoptive and guardianship caseloads. We highlight the needs of a twenty-first century child welfare system, including increased federal efforts to ensure child permanence and well-being after legal adoption or guardianship has been achieved, as well as more rigorous longitudinal and interdisciplinary research focused on the post-permanency adjustment of children and their families.     

Internalizing symptoms linking youths' maltreatment and delinquent behavior

This study examines internalizing mental health symptoms (depression and posttraumatic stress disorder) as potential intervening factors in the relationship between maltreatment and delinquency using data from the National Survey for Child and Adolescent Well-Being (N = 1179). Significant mediating effects indicated that youth at greater risk of maltreatment experienced higher levels of internalizing symptoms that result in increased risk for delinquent behavior, although longitudinal effects were not supported. These findings highlight internalizing mental health symptoms as an important factor to address in treating victimized children at risk of future delinquency. Implications for child welfare service provision are discussed.     

Factors affecting post-permanency adjustment for children in adoption or guardianship placements: An ecological systems analysis

Despite a growing body of research on post-permanency adjustment for children adopted from public child welfare agencies, many studies lack a systematic review using a theoretical framework. To develop promising post-permanency services for adopted children with special needs and their families, the first step is to examine risk and protective factors affecting adoption or guardianship adjustment. This study systematically reviews and synthesizes current empirical studies investigating post-permanency outcomes using an ecological systems analysis, with an integration of family theories. A search of five electronic databases and relevant child welfare books identified 36 empirical studies on post-permanency adjustment. Risk factors include some individual factors such as caring for a child with special needs, raising children with a multiple placement or maltreatment history and involving parents with no parenting experience. Living in a family experiencing boundary ambiguity and lacking social support are also risk factors. Protective factors include having adoption preparation and having a child living with married parents, as well as a high level of adoption openness and the availability of formal and informal social support. Implications for child welfare practice and policy also are discussed.     

Envisaging the adoption process to strengthen gay- and lesbian-headed families: recommendations for adoption professionals

Although a growing number of child placement agencies are serving lesbians and gay men, a dearth of literature exists for adoption agency policies and practices related to working with this population. This article explores the unique characteristics and strengths of prospective gay and lesbian adoptive parents throughout each of the three phases of the adoption process-preplacement, placement, and postplacement-as well as provides suggestions for adoption professionals working with gays and lesbians. Data from a recent qualitative study of single, gay adoptive fathers are used to illustrate examples and expose areas of potential strengths of adoptive parents not generally explored in the preplacement or preparatory stage. Special attention also is given to the continuing needs of adoptive families headed by gays and lesbians after adoptive placement. Specifically explored are the needs for developing linkages with similar families, as well as providing resources designed to promote successful outcomes of adopted children raised by gays and lesbians.     

Relationship of risk assessment to placement characteristics in a statewide child welfare population

Risk assessments allow child and youth services to identify children who are at risk for maltreatment (e.g., abuse, neglect) and help determine the restrictiveness of placements or need for services among youth entering a child welfare system. Despite the use of instruments by many agencies within the U.S. to determine the appropriate placements for youth, research has shown that placement decisions are often influenced by factors such as gender, age, and severity of social–emotional and behavior problems. This study examined ratings of risk across multiple domains using a structured assessment tool used by caseworkers in the Rhode Island child welfare system. The relationship between ratings of risk and placement restrictiveness was also examined. Risk levels varied across placement settings. Multivariate analyses revealed that lower caseworker ratings of parent risk and higher ratings of youth risk were associated with more restrictive placements for youth. Implications for the child welfare system are discussed.     

Placement Discontinuity for Older Children and Adolescents Who Exit Foster Care Through Adoption Or Guardianship: A Systematic Review

For over two decades, practitioners, advocates, and scholars involved with the U.S. child welfare system have engaged in coordinated efforts to increase the number of foster youth who find stable, permanent homes through adoption or guardianship, and these efforts have been shaped and guided by federal policies and directives. As a result, the number of children adopted or placed into guardianship out of foster care has increased significantly. This trend has significant implications for child welfare research, policy, and practice. However, the risk and protective factors for post-permanency discontinuity, or placement changes that occur after legal finalization of an adoption or guardianship, have received little attention in the literature. Also, many previous studies that investigated post-permanency adjustment for former foster youth have been limited by serious design and/or conceptual flaws. The purpose of this study is to investigate the peer-reviewed literature that examines risk or protective factors for discontinuity, or outcomes proximal to discontinuity, for older foster youth. A systematic search located 18 quantitative, quasi-experimental studies published in peer-reviewed journals that implemented multivariable methods. This review finds that the quality of the research evidence is generally weak, but previous studies do suggest several risk and protective factors for post-permanency discontinuity, including child, family, and service characteristics.     

Contributors to adjustment problems of adoptees: A review of the longitudinal research

Retrospective studies of adoptive families have identified ways in which members of the adoptive family may be at risk of behavior and adjustment problems, but it is prospective research which can link those difficulties to factors which exist early in the placement. This review of prospective adoption research finds that most studies, but not all, report that adopted children are indeed at increased risk of behavior problems and decreased selfesteem. These studies, taken in sum, caution that unrealistic parental expectations and other parental misconceptions about the child, particularly regarding academic achievement, often lead to these difficulties in adjustment. Implications for practive are discussed.     

Inter‐professional working in child protection with families with long‐term and complex needs

Within the United Kingdom there is growing awareness of the need to identify and support the small number of children who are living in families experiencing multiple problems. Research indicates that adverse experiences in childhood can result in poor outcomes in adulthood in terms of lack of employment, poorer physical and mental health and increases in social problems experienced. It is acknowledged that most of these children are known to child welfare professionals and that some are referred to social services, subsequently entering the child protection system. This paper reports research conducted with 28 experienced child welfare professionals. It explores their views about families known to the child protection system with long‐term and complex needs in relation to the characteristics of children and their families; the process of intervention with families; and the effects of organisational arrangements on practice. The research indicates that these families are characterised by the range and depth of the problems experienced by the adults, such as domestic violence, mental health difficulties and substance misuse problems, and the need for professionals to have good inter‐personal skills and access to specialist therapeutic services if families are to be supported to address their problems. Copyright © 2008 John Wiley & Sons, Ltd.     

Assessing lesbian and gay prospective foster and adoptive families: a focus on the home study process

Foster care and adoption by gay men and lesbians is not a new phenomenon. Children and youth have always been placed by states and public agencies in homes with gay and lesbian parents. Some gay men and lesbians have fostered or adopted children independently from private agencies or have made private adoption arrangements with individual birthmothers, while others have fostered or adopted through the public system. Drawing on research literature, practice wisdom from 31 years of child welfare experiences, and case examples, this article offers child welfare professionals guidelines for competent assessment with prospective foster or adoptive parents who identify as lesbian or gay.     

The Youngest Victims of Violence: Examining the Mental Health Needs of Young Children Who Are Involved in the Child Welfare and Juvenile Justice Systems

Children placed in the state’s custody due to neglect, abuse or maltreatment are one of America’s most vulnerable populations. Seventy-five percent of child victims of maltreatment are under the age of 12. Not only is their suffering a problem, these children are also at increased risk for delinquent behavior later in life. While research has documented the potential long-term consequences of child abuse and neglect, the mental health needs of young children involved in the foster care and juvenile justice systems have been largely overlooked. This study examined the social, emotional and behavioral difficulties of 670 children, age 3–11, who were involved in the child welfare and juvenile justice systems. Children in this study were living in residential treatment facilities, group homes, foster care homes or were receiving intensive home-based services. To assess the children’s mental health needs caregivers completed the parent form of the Strengths and Difficulties Questionnaire (Goodman, Journal of Child Psychology and Psychiatry 38:581–586, 1997). The findings indicated a high prevalence of mental health problems, with 81 % of the children in the sample having a total difficulties score in the borderline or abnormal range and 90 % of the children having borderline or abnormal scores on at least one of the subscales (conduct, emotional, peer or attention problems). When characteristics such as gender, race and age were considered significant differences were found among boys and girls, Caucasian and minority children, and age groups. The findings highlight the importance of mental health assessment and interventions that are gender and culturally sensitive and developmentally appropriate.     

Exploratory analysis of child protection mediation permanency placement outcomes

Using a merged data set constructed from empirical data obtained from Child Protective Services (CPS) and a nonprofit agency tasked with conducting an evaluation of a child protection mediation pilot project in the state in which this study was conducted, this study (N = 311) explores how various child and family factors in child protection mediation cases affect placement outcomes for children in care. Results of the multinomial logistic regression (MLR) analyses found that children for whom parent/caregiver substance abuse and/or mental illness was an issue were less likely to be reunified with their parents than remain in care. Those children who experienced a higher number of placements and those who were male were less likely to be placed with relatives. Children whose parents experienced mental health issues were less likely to be placed with a relative. With regard to the permanency outcome of adoption, the findings showed that as the age of the child at time of removal increased, children were less likely to be adopted than remain in care. Additionally, African American children in the sample were less likely to be adopted.     

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.     

Child welfare caseworkers' perspectives on the challenges of addressing mental health problems in early childhood

Although nearly half of child maltreatment victims are under the age of five and at high risk for developing serious emotional or behavioral problems, few young children involved in the child welfare system receive treatment. As the first point of service contact, child welfare caseworkers can play a key role in quickly identifying children with mental health problems and linking them to services. This study examines caseworkers' perspectives on the challenges of addressing mental health problems in early childhood. Based on five focus groups conducted with 50 caseworkers from an urban, public child welfare agency, results suggest that although workers acknowledge the importance of early intervention, difficulty identifying mental health needs in early childhood and workplace barriers impede linkage to services. Given the lasting impacts of early experiences on children's development, it is imperative that these challenges be addressed. Implications for systematic mental health screening and caseworker training are discussed.