Foster care and Medicaid managed care

Children in the foster care system are often dependent on Medicaid for health care. These children, however, have more complex health care needs than the typical child receiving Medicaid. States are implementing Medicaid managed care programs as a way to control escalating costs while providing necessary services. This article reviews the issues surrounding delivery of managed health care services to children in foster care and describes several solutions.     

Issues of shared parenting of LGBTQ children and youth in foster care: preparing foster parents for new roles

Foster parents have increasingly assumed new and challenging roles during the past decade. Meeting the developmental, attachment, and grieving needs of children and youth in out of home care is challenging by itself, but can become even more difficult with the issues that arise when the child is lesbian, gay, bisexual, transgender, or questioning (LGBTQ). Preservice and in-service foster parent training programs can strengthen shared parenting skills by focusing on the universal critical issues of safety, well being, and permanence for children and youth in foster care. This article will focus on these skill areas: (1) sharing parenting to promote healthy growth and development of LGBTQ youth in foster care, (2) threats to safety of LGBTQ youth in foster care, and (3) general challenges and strategies for preparing foster parents of LGBTQ youth to build support systems.     

Decision-making skills of emerging adults aging out of foster care

This study examines the decision-making skills of emerging adults that have aged out of foster care and transitioned to independent life. Emerging adults face a wide variety of life-direction determining decisions and those aging out of foster care experience even more significant transitional issues. Youth aging out of foster care may lack the requisite decision-making competencies for coping with these challenges. This study compares the decision-making skills of foster care alumni to a group of similar individuals who were not involved in the child welfare system. Using a validated quantitative survey instrument, 29 foster care alumni and 29 demographically similar non-fostered participants described their general decision-making skills and elaborated on their personal experiences of reaching the age of majority. Statistical analyses of group differences indicate foster alumni score lower on overall decision-making skills and the decision-making process. In anecdotal comments, foster alumni tended to focus on their experience of leaving the foster system, while the non-fostered population elaborated on what it was like to become a legal adult. This study suggests that youth aging out of the foster care system may need support with the aspects of decision-making relating to the generation of alternatives and inferential reasoning about decision consequences as one way to augment and improve the transitional services designed to prepare foster youth for independent life.     

Enhancing the validity of foster care follow-up studies through multiple alumni location strategies

While family-based placement prevention services, family reunification programs, subsidized guardianship, and aggressive adoption programs are reducing the numbers of children spending long periods of time in substitute care, a significant number of America's children will come of age in foster care. Agencies and policymakers should use research and evaluation to assess the effectiveness of foster care in nurturing healthy adults and to explore ways to improve services. Outcome studies that have focused on locating and interviewing young or middle-aged adults emancipated from foster care have been hampered by modest response rates, limiting the field's ability to evaluate the efficacy of foster care programs. This article describes a set of strategies that were used to achieve higher response rates in two recent follow-up studies.     

Foster Parents' Understanding of Children's Problematic Attachment Strategies

ABSTRACT

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

Designing a campus support program for foster care alumni: Preliminary evidence for a strengths framework

Campus support programs for foster care alumni (FCA) have emerged in an attempt to improve higher education outcomes for former foster youth. However, these programs have little empirical or theoretical literature to guide their development. We present a case study of a newly developed campus support program for FCA which utilizes a strengths perspective. We analyze quantitative and qualitative data collected before and during the first two years of program operation to explore whether a strengths perspective can be successfully applied to the unique needs of FCA in higher education. Results reveal that the strengths perspective has potential and identifies three areas in which this approach appears to effectively intersect with challenges faced by FCA, a) promoting positive identities as survivors, b) respecting autonomy, and c) mobilizing assets of resilience, perseverance, and community. We discuss the benefits and challenges of helping students address these issues. Our findings also reveal that the strengths perspective is not redundant with traditional higher education retention models, and in the three areas identified, is diametrically opposed to the students' previous experiences with the foster care system.     

Special foster care for exceptional children:: A review of programs and policies

This article reviews programs and policies regarding alternative home care for exceptional and special-needs foster children. While some focus is placed on program evaluation and efficacy of these specialized foster homes, the major thrust of the review is to identify major procedural underpinnings of successful programs for special needs foster children. These include: (a) appropriate selection of qualified therapeutic parents; (b) preservice training of parents; (c) matching of child to abilities of parents; (d) high-intensity and high-frequency casework and consultation; and (e) professional status for the specialized foster parents. Special foster care programs which have been evaluated offer generally high levels of success and goal attainment at much lower per diem rates than institutional care. Summary policies and recommendations are forwarded.     

MEDIA REVIEWS

Abstract

This article looks at print coverage of various adoption issues: adoption vs. abortion, a famous birth mother's story, revisiting Baby Richard, and the perils of internation adoption. Two prime time programs are reviewed, one drama on foster care and open adoption, the other a newsmagazine segment on failure to disclose medical problems in adopted children.     

Using the bridges transition framework for youth in foster care: Measurement development and preliminary outcomes

Youth in foster care often undergo multiple transitions before reaching adulthood, and these transitions often create significant stress and can exacerbate emotional and behavioral problems. A measurement instrument (the Youth Experience of Transitions, or YET) was designed to assess foster care youths' understanding of transitions, and this instrument was tested on a group of youth undergoing an intervention program designed to assist them in coping with the stress of these transitions while in foster care. The intervention was based on the Transitions Framework by William Bridges and was implemented in multiple community agencies with funding from the Andrus Family Fund. Using factor analysis, we found that the YET contained two factors representing (1) openness and (2) determination. For youth in the participating foster care programs, growth in openness from baseline to 6 months was linked to a significant decrease in internalizing symptoms; no significant links were found for externalizing symptoms. Implications for foster care intervention programs are discussed.     

Clinical aspects of the training of foster parents

This paper recognizes that training programs for foster parents are as good as their implementation for which the author emphasizes the need for clinical expertise. It is important to help foster parents emphasize and understand issues of grief over loss and separation and the child's expressions through behavior. Techniques to help foster parents with these issues are identified.     

Foster care transition services for youth with disabilities: findings from a survey of county service providers

This study explores the transition services available for youth with disabilities in foster care and the collaboration among foster care transition programs with other types of providers. Findings from this survey of independent living coordinators working for child welfare agencies indicate that while youth with disabilities are being served through transition programs and these programs collaborate with other government agencies, there are few services targeted directly toward their needs, little collaboration with community-based agencies, and a need for more information sharing.     

Barriers to Implementing a Mentoring Program for Youth in Foster Care: Implications for Practice and Policy Innovation

The aim of this article is to report on the findings of an evaluation of a youth in foster care mentoring pilot program and the difficulty that arises when a program is not well implemented. The pilot program and evaluation of its effectiveness were mandated by the Texas 80th Legislature through the passing of HB 3008. Big Brothers Big Sisters of North Texas implemented the pilot to match youth in foster care age 14 years and older, who participate on a voluntary basis and who have been screened for participation by the Texas Department of Family and Protective Services (DFPS) with an adult mentor. As part of the pilot, youth were to receive 8 h of face-to-face time, and at least 1 h of phone, email, or text contact with their mentor. Though there were problems with implementation of the mentoring pilot, responses on the confidential youth survey suggest that those who did participate had positive experiences. Based on responses on the survey from the youth and based on the existing empirical literature on the benefits of mentoring programs for trouble youth and following the recommendations presented in this article the mentoring programs should be encouraged for youth aging out of foster care.     

The invisibility of adolescent sexual development in foster care: Seriously addressing sexually transmitted infections and access to services

Adolescents residing in foster care are at higher risk for acquiring sexually transmitted infections (STIs) and human immune deficiency virus (HIV) compared to their non-foster care peers. A literature review was conducted to determine whether youth residing in foster care face different barriers to sexual health care compared to their peers in the general population and, if so, what those barriers are. The review revealed barriers common to adolescents in general as well as additional barriers specific to the ecosystem of adolescents in foster care. Systemic issues that decreased access to sexual health services included child welfare policies that were either missing or implemented without fidelity; complicated financial factors; barriers to service utilization; lack of collaboration between child welfare and medical professionals; and limited information provided to foster youth on their sexual health and development. Consent and confidentiality issues that foster youth face in seeking sensitive health services also need to be resolved. More research is needed on how to facilitate development of coherent policies and effective practices that promote sexual health care access for adolescents in foster care.     

Sexual and reproductive health policies for foster youth in California: A qualitative study of child welfare professionals' experiences and perceptions of policies

Child welfare professionals and foster parents increasingly suggest the importance of establishing clear and consistent policies and procedures to address the sexual and reproductive health of youth in foster care. The present study examines the content and context of such policies across 18 California counties through a search of publically available county policy documents, and surveys and expert interviews with child welfare professionals (N = 22). A policy framework for agenda setting and policymaking was used to guide the data collection and analysis process. Child welfare professionals were aware of multiple sources of information, support and services for foster youths' sexual and reproductive health, though few practiced in counties with formal policies that outline the resources and support that youth should receive. Participants demonstrated widespread recognition that issues of youth sexual and reproductive health were significant; posing challenges to youth, foster parents and child welfare staff. Identified policy solutions included: 1) training for social workers and foster parents; 2) collaborative partnerships with public health nurses and community providers; 3) data tracking and monitoring of outcomes to assess youth needs and evaluate the impact of programs and policies; and 4) involvement by advocacy organizations in defining problems and advocating for improved services and support for youth in care. Social workers largely perceived that support from child welfare administrators and policy leaders is necessary to prioritize this issue and initiate policy formation. Additional research is needed to further examine the impact of policy mandates on social workers, foster parents and youth in foster care.     

Functioning patterns among older adolescents in foster care: Results from a cluster analysis

Older adolescents in foster care represent a heterogeneous population, though such heterogeneity is often underemphasized in research and practice. This study employed a cluster analysis to identify subpopulations in a large, national sample of 17-year-old youth based on the following indicators: educational attainment, connection to a supportive adult, adolescent parenthood, homelessness, substance abuse referral and incarceration. Data from the National Youth in Transition Database (NYTD) and Adoption and Foster Care Analysis and Reporting System (AFCARS) were used in the analysis. Results revealed five subpopulations defined by specific strengths, vulnerabilities and child welfare experiences. The largest group identified (39%) functioned successfully in all domains, whereas an additional group (15%) exhibited consistent maladaptation. The remaining groups evidenced variable adaptation patterns, with strengths in some domains and challenges in others. Entry to foster care for reasons other than child's problem behaviors, and placement in stable, family-based settings were associated with belonging to the most adaptive group. Findings emphasize heterogeneity among older adolescents in foster care, and call for better design and targeting of child welfare services and programs as appropriate to the needs of specific subgroups.     

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.     

Increasing College Access and Retention Rates of Youth in Foster Care: An Analysis of the Impact of 22 State Tuition Waiver Programs

Youth in foster care face educational disparities in terms of college access, retention, and graduation. To address this, 22 states have implemented tuition waiver programs targeting current and former foster youth. A comparative analysis was conducted of all 22 programs implemented since 2014. Similarities include student eligibility based on youth’s age upon foster care entry, university admission and time in care requirements. Differences include type of expenses covered, time limits on use, program oversight, and funding availability. No differences were found based on political party control, gubernatorial power, and state population composition. Recommendations for policy and practice reform are offered.     

Pediatricians and foster children

The poor state of health and health care of foster children is well documented. The cure lies in the hands of the agencies that administer the foster care system and pay for medical services, and in those of the physicians who provide that care. This study suggests that much of the problem may be solvable. Adequate numbers of pediatricians in Connecticut seem to be committed to caring for foster children, but major impediments remain, including inadequate reimbursement for both primary and specialty health services. The institution of a medical passport can make needed information available and help to establish and promote standards of care. Pediatricians appear willing to take a leadership role in assisting other agencies in developing programs to improve the care of these children; despite the problems in providing medical care to foster children, most pediatricians view it as part of their responsibility to the community and to all children.     

Lives in Motion: A Review of Former Foster Youth in the Context of their Experiences in the Child Welfare System

In light of the poor prospects facing many former foster youths during the transition to adulthood, it is surprising that so little attention has been given to substitute care contexts during child welfare system involvement. A review of child welfare research finds that many former foster youths go through an alarming number of placement changes and report a high rate of placement into congregate care settings and other unplanned events. Future research should take explicit account of substitute care contexts in designing and carrying out studies examining the adult outcomes of aging out foster care populations. Interventions intended to circumvent high rates of movement in foster care should also be broadened to target multiple aspects of substitute care contexts.     

Prevalence,experiences, and characteristics of children and youth who enter foster care through voluntary placement agreements

A voluntary foster care placement (sometimes referred to as a voluntary placement agreement) is an agreement, entered into without court involvement, between a state or county child welfare agency and a child's parents to place a child into out-of-home placement. When a child enters foster care through this type of placement, state and federal programs that cover children who enter child welfare due to a court order become the custodians of the voluntarily-placed-child's placement, care, and supervision. In this cross-sectional, exploratory study, data from the Adoption and Foster Care Reporting System (AFCARS) was used to examine the characteristics and experiences of children who enter foster care through a voluntary foster care agreement, and to compare them with those of children who enter foster care through a court order. Findings indicate that children who are placed through a voluntary placement agreement differ from children who enter through a court order in their personal characteristics, as well as in their placement settings, length of placement, and manner of discharge from foster care. This study provides a baseline for future research into this area of child welfare practice.