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.     

Underserved parents,underserved youth: Considering foster parent willingness to foster substance-using adolescents

Adolescents involved with foster care are five times more likely to receive a drug dependence diagnosis when compared to adolescents in the general population. Prior research has shown that substance use is often hidden from providers, negating any chance for treatment and almost guaranteeing poor post-foster care outcomes. There are virtually no studies that examine the willingness (and its determinants) to foster youth with substance abuse problems. The current study conducted a nationally-distributed survey of 752 currently licensed foster care parents that assessed willingness to foster youth overall and by type of drug used, and possible correlates of this decision (e.g., home factors, system factors, and individual foster parent factors such as ratings of perceived difficulty in fostering this population). Overall, willingness to foster a youth involved with alcohol and other drugs (AOD) was contingent upon the types of drugs used. The odds that a parent would foster an AOD-involved youth were significantly increased by being licensed as a treatment foster home, having fostered an AOD-involved youth in the past, having AOD-specific training and past agency-support when needed, and self-efficacy with respect to positive impact. Surprisingly, when religion played a large part in the decision to foster any child, the odds of willingness to foster an AOD-involved youth dropped significantly. These results suggest that a large proportion of AOD-involved youth who find themselves in the foster care system will not have foster families willing to parent them, thereby forcing placement into a variety of congregate care facilities (e.g., residential treatment facilities, group homes). Specific ways in which the system can address these issues to improve placement and permanency efforts are provided.     

Responsive engagement in mental health services for foster youth transitioning to adulthood

ABSTRACT

As youth near the transition to adulthood and aging out of the foster care system, exposure to stress increases, especially for youth who have less-than-adequate support systems. Although mental health problems among foster youth often continue into adulthood, service use decreases dramatically within a year of turning age 18. Understanding how foster youth experience mental health services as they transition from care provides social workers and other mental health professionals important insight that can lead to specific, targetable strategies. This study sought to explore what situations were helpful in supporting mental health as foster youth transitioned to adulthood. Focus groups and interviews with former foster youth and professionals informed the development of a quantitative instrument, which was used to identify the most supportive and frequently encountered situations former foster youth experienced. Findings indicate the most helpful situations were those in which professionals and mentors were flexible and responsive to their individual needs and trusted their ability to make decisions. Supportive adults who honored their choices and collaborated in decision-making were also helpful. Engaging, empowering, and partnering with transition-age youth may increase the likelihood of positive mental health outcomes for this population, offering implications for family-centered, strengths-based practice.     

Typologies of substance use and illegal behaviors: A comparison of emerging adults with histories of foster care and the general population

This study used latent class analysis (LCA) to explore whether patterns of substance use and illegal behaviors among emerging adults, 18 to 28 years old, differ depending on whether they have a prior history in foster care. The study sample, consisting of 316 respondents who had previously been in foster care and 14,301 respondents without a foster care history, was drawn from the third wave of the National Longitudinal Study of Adolescent Health. A multiple-group LCA compared former foster youth to their peers in the general population. The following four classes were identified: illegal behaviors, substance use, illegal behaviors with problematic substance use and normative behaviors. Most of the differences between the groups were not statistically significant. However, within the illegal behavior class former foster youth were less likely to have bought, sold, or held stolen goods; injured someone in a fight so that she or he needed medical attention; to have sold drugs; and to have been drunk at school or work. Additionally, in the illegal behaviors with problematic substance use class emerging adults in the general population were more likely to have used cocaine. Within the normative behaviors class, former foster youth were more likely to be current smokers, and to have injured someone in a fight so that he or she required medical attention. Within the substance use class, emerging adults from the general population were more likely to have taken place in a fight where one group fought another. Additional statistically significant, but very small differences were also identified.     

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.     

Do Foster Parents and Care Workers Recognize the Needs of Youth in Family Foster Care with a History of Sexual Abuse?

Children in family foster care have the right to participate in decisions regarding their life, however, adults often advocate on behalf of children. This Q methodological study explored whether shared perspectives among foster parents and care workers resemble shared perspectives of youth regarding the psychosocial needs experienced by youth with a history of sexual abuse. Participants sorted a set of statement cards according to what they thought was most important for youth. By-person factor analyses examined how the Q sorts of foster parents and care workers related to those of youth. The results showed that foster parents mostly recognized the group of youth who value an instrumental relationship with their carers, while care workers mostly recognized the group of youth who value support of both foster and birth parents with regard to their preparation for independent living. The two youth groups characterized by ambivalence and autonomy were barely recognized. Results are discussed in light of the expected roles of foster parents and care workers, and youth’s contact with birth parents. Lastly, this study highlights the importance of youth participation, because youth offer unique and varying perspectives about their needs.     

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.     

The relationship between re-incarceration and their own childhood foster care experience of women

Using matched state administrative records of women in the Illinois state prison system, we investigate whether incarcerated women with foster care experience during their early (aged 10 to 14) and late (aged 15 to 18) teens do better or worse in re-incarceration rates compared to female counterparts who went to prison but had no foster care experience. We find that women with the early-teen foster care experience have higher rates of re-incarceration than women without foster care, regardless of whether they were reunited with their parents. The adverse association between the first foster care placement during early-teens and re-incarceration is particularly stronger among former female inmates with low education or history of drug addiction than others. We conclude that incarcerated women with foster care experiences, especially in their early teens, need more attention and extra support from the appropriate institutions upon their release. In addition, it seems that foster care can work as a strong signal of possible re-incarceration among women with low education and history of drug addiction.     

Children’s Psychosocial Rehabilitation: Clinical Outcomes for Youth with Serious Emotional Disturbance Living in Foster Care

Children living in foster care are an especially vulnerable population who often come to the attention of Medicaid mental health providers. These children experience a high incidence of emotional and behavioral disorders and may have specialized treatment needs related to their living arrangement status. This study assessed whether Children’s Psychosocial Rehabilitation could effectively treat youth with severe emotional and behavioral disorders who live in foster care. Analysis of data from an open trial of 218 clinically-impaired youth, aged 3–18 years, revealed no reliable differences in treatment outcome between foster versus non-foster children, with a trend toward more favorable outcomes for foster youth. Findings justify further study of the effectiveness of this Medicaid-funded service for the treatment of youth in care.     

Perceived self-stigma in the utilization of mental health services in foster care and post foster care among foster care alumni

Foster youth experience higher rates of mental health disorders and receive higher rates of mental health services in comparison to the general population. Yet, upon foster care exit, mental health service use drastically declines. Little is known as to the reasons for mental health service decline after foster care exit. However, research studies in the mental health literature have consistently shown that self-stigma and public stigma are significant in mental health service receipt. Studies have also shown that self-stigma affects an adolescent's self-identity, self-efficacy, and interpersonal relationships, which impact self-sufficiency once youth leave foster care. This study explores self-stigma in the utilization of mental health services while in foster care, and whether the stigma developed while in foster care impacts mental health service use upon foster care exit. The role of public stigma in the utilization of mental health services post foster care is also examined. Thirteen former foster youth with a mental health treatment history while in foster care were interviewed. Results show that foster youth experienced self-stigma, which increased the negative impact of mental health service receipt while in foster care. After foster care exit, youth who identified experiencing self-stigma while in foster care tended to discontinue mental health services after foster care exit. In contrast, foster youth who did not identify self-stigma in the receipt of mental health services while in foster care continued accessing services upon foster care exit. Public stigma was not identified as influencing mental health service use post foster care, but was coupled with negative labels, stereotypes, and negative perceptions. Implications for preventive and intervention measures are also discussed/proposed.     

Modeling initiation into drug injection among street youth

This study aimed at examining the predictors of initiation into drug injection among street youth using social cognitive theory framework. A prospective cohort study based on semi-annual interviews was carried out. Psychosocial determinants referred to avoidance of initiation. Other potential predictors were: sociodemographic characteristics, relationships with injectors, parent's substance misuse, drug use patterns, homelessness, survival sex, sexual abuse. Independent predictors were identified using Cox proportional hazards regression models. Among the 352 participants, high control beliefs about avoidance of initiation was protective while younger age, daily alcohol consumption, heroin use, cocaine use, and survival sex all increased risk of initiation. Preventive strategies targeting street youth should both enhance youth's control beliefs and actual control over their substance use and improve their life conditions.     

Academic resilience and caring adults: The experiences of former foster youth

As a result of being removed from their homes and moving between different placements and schools, foster youth can experience high levels of stress and challenges as they struggle to cope with such extreme emotional turbulence. The experience of trauma and instability in turn, can have consequences on foster students' academic progress. As it is seemingly uncommon for foster youth to matriculate to postsecondary education, this study examines how successful foster youth transitioned out of care and furthered their education at an academically rigorous institution. From high-achieving former foster students, this study uncovers their experiences while in out-of-home care that helped them enroll in a university, including how adult supporters provided guidance, emotional support, and stability, which allowed students to move out of their negative past experiences. Adults' willingness to assist youth and be a part of their lives provided students with a transformative academic and social emotional environment, furthering their ability to persist through high school and gain acceptance to a top-tier university.     

On their own: The experiences of youth after foster care

This study used multiple means to identify 55 young adults who had left foster care in recent years. The young adults who had all emancipated from foster care under the auspices of social services were most often identified by former foster parents, social workers, or other foster youth. This sample of former foster youth are often struggling with ill health, poor educations, severe housing problems, substance abuse, and criminal behavior. Yet the youth in this sample may be surviving more ably than the many former foster youth whom we could not reach.The author thanks Rich Clarke, Pat Lovelock and Sharon Ikami. This study was prepared under Contra Costa County Contract #20-719.     

Exploring the Experiences of Lesbian,Gay, Bisexual,and Questioning Adolescents in Foster Care

This article is based on the findings from a subset of gender identity and sexual orientation questions from The Casey Field Office Mental Health Study (CFOMH). It aims to contribute the experiences of youth in the care of Casey Family Programs to the increasing body of research on lesbian, gay, bisexual, transgender, or questioning (LGBTQ) youth in foster care, as well as inform future studies in this area. The CFOMH study interviewed 188 adolescents ages 14 to 17 who were receiving foster care services from Casey Family Programs in 2006. The experiences in care of youth who identified as LGBQ (n = 10) are presented in narrative form, along with data from all youth in care (N = 188) regarding their perceptions of the foster care environment for LGBTQ youth. These findings are intended to underscore the need to conduct a larger, more in-depth study of the experiences of LGBTQ youth in foster care and the environment that foster care provides for them.     

“I don't know where I would be right now if it wasn't for them”: Emancipated foster care youth and their important non-parental adults

Research has identified the benefits of having non-parental adults for older youth in foster care, but less is known about the characteristics of these relationships, as well as the processes that support the foster youth as they transition from care to independence. The present study included a diverse group of 99 young adults, who recently emancipated from care in a major U.S. city. These young adults reported having a very important non-parental adult (VIP) and 63 of these VIPs were also included in this study. The youth participated in a two-hour in-person interview followed by a survey, and the VIPs underwent a phone interview; all of these interviews were later transcribed and qualitatively coded using thematic analysis. Overall, this study aimed to: 1) identify the characteristics of these VIPs, and 2) elucidate how the VIPs support youth during the transition from care. Prominent characteristics of the youth and VIP relationship identified in this study include the relationship being “parent-like”, respectful, and reciprocal with regards to communication. Moreover, it was found that both the youth and the VIPs viewed these relationships to be important in reducing negative outcomes for the youth. These results call for the foster care system to take steps in helping foster care youth find and build relationships with the non-parental adults in their lives — VIPs can serve as important sources of support to aid foster youth in their adaptation to young adulthood.     

In their own words: Overcoming barriers during the transition to adulthood for youth with disabilities who experienced foster care

The transition to adulthood can be especially challenging for youth who experience the foster care system. These challenges are magnified for youth with disabilities, who account for at least 40–47% of all children in foster care (Powers et al., 2012). In order to move from a deficit-based to a strength-based approach, this qualitative study focused on understanding the lived experience of transitioning to adulthood for alumni of foster care with disabilities. Semi-structured interviews were conducted with seven young adults who had exited care over a six-month time period. Participants described their journeys from foster care to independence and articulated a vision for a successful adulthood. Key themes that emerged included a desire for stability and personal fulfillment in adult life. Participants also identified common barriers encountered including unmet mental health needs and lack of disability awareness or the implications of mental health diagnosis. Personal strengths that helped overcome those barriers included resilience, advocacy, and self-determination.     

Happily Ever After? The Journey From Foster Care to Adoption

Providing the foster child with a forever family through adoption is often seen as a happy ending to the long and painful journey through foster care. This qualitative study explores this complex journey from foster care to adoption from the perspective of 30 young adults aged 18 to 25 who were adopted from the foster care system after the age of 8. The results indicate that the foster and adoption experience for these youth cannot be compartmentalized when trying to understand the impact adoption has had on their overall sense of self. Implications for future research to explore the emerging concept of foster/adoptive identity for older youth adopted through the foster care system are provided.     

Sibling relationships and internalizing symptoms of youth in foster care

Compared to the sibling literature of the general population, little is known about sibling relationships of youth in foster care. The current study aimed to report on sibling relationships among youth in foster care, and investigate the potential protective nature of sibling relationships of those who have experienced trauma on the expression of internalizing symptoms among a nationally representative sample of 152 adolescents in foster care. Results indicated that the large majority of the sample was currently separated from their sibling. Of those who were not living with their sibling, nearly three quarters saw their sibling monthly or less frequently with one third of the sample reporting never having any contact with their sibling. In addition, bootstrapping methods were used to determine if sibling relationships mediated the effect of trauma on internalizing symptoms. Results indicated that a positive sibling relationship significantly mediated this relationship. Implications of these findings are discussed.     

Tobacco use among foster youth: Evidence of health disparities

Youth aging out of foster care face a challenging road to independence. Following exposure to myriad risk factors such as abuse, neglect, parental substance use, and severe housing mobility, supportive services decrease upon exit from care, often increasing risk for substance use, homelessness, and unemployment. Although tobacco use is also highly prevalent, little attention has been paid to screening, assessment, and treatment of tobacco use in this vulnerable group. The current study (N = 116) reports on tobacco use prevalence, consequences, and co-occurrence with other substances in a sample of youth (ages 18 to 19) exiting the foster care system. In the face of an overall decrease in tobacco use among general population adolescents and young adults, results suggest disproportionate levels of lifetime, recent, and daily use among foster youth. Prevalence of recent tobacco use (46%) is nearly triple national rates, while daily smoking (32%) is almost four times that of general population young adults. Tobacco users were more likely than non-users to drink (70% vs. 40%) and to smoke marijuana (72% vs. 25%). We strongly encourage researchers and practitioners to increase attention to this tobacco-related health disparity.     

An asset-based approach to facilitating positive youth development and adoption

The present study examined outcomes for youth in foster care who participated in an asset-based camp designed to build youth assets and facilitate adoption. The study addresses youth perceptions of their assets and the relationship between assets and adoption status. Youth perceived that their assets increased over time and adopted youth reported having more assets than youth who were not adopted. An asset-based approach may lead to positive outcomes for youth in foster care.