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.     

Educational and employment outcomes of adults formerly placed in foster care: Results from the Northwest Foster Care Alumni Study

This study evaluated the intermediate and long-term effects of family foster care on adult functioning using a sample of 659 young adults from two public and one private child welfare agencies, case record reviews, structured interviews, and a survey response rate of 76%. Foster care alumni completed high school at a rate comparable to the general population, but a disproportionately high number of them completed high school via a GED. Alumni completion rates for postsecondary education were low. Consequently, many alumni were in fragile economic situations: one-third of the alumni had household incomes at or below the poverty level, one-third had no health insurance, and more than one in five experienced homelessness after leaving foster care. Two foster care experience areas were estimated to significantly reduce the number of undesirable outcomes in the Education outcome domain: positive placement history (e.g., high placement stability, few failed reunifications), and having broad independent living preparation (as exemplified by having concrete resources upon leaving care). For the Employment and Finances outcome domain, receiving broad independent living preparation (as exemplified by having concrete resources upon leaving care) was estimated to significantly reduce the number of undesirable outcomes.     

The first three years after foster care: A longitudinal look at the adaptation of 16 youth to emerging adulthood

Sixteen former foster youth were followed for 3 years to examine their adaptation to emerging adulthood. Youth were classified on their adaptation according to 2 concepts, Connectedness and Risks. Connectedness refers to engagement with the adult world through work, schooling, marriage, and parenthood. Risks refer to problems with substance abuse, financial difficulties, and mental health problems that would hinder engagement with the adult world. All of the youth maintained at least one adult connection, but only 6 youth did not have a risk at the final interview. Three years after discharge 50% of the respondents had a drug and/or alcohol problem, and had neither savings nor health insurance. Despite many problems the post foster care period was marked by much resilience as most struggled to remain independent, and continue their schooling. Factors which facilitated successful adaptations were: a period of transitional residence after foster care, good support systems including family and former social workers, and a commitment to further education.     

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.     

Socioemotional characteristics of minors in foster care: A comparison between the estimation of parents,teachers and children

During the child's first few years, it's of fundamental importance the presence of a strong emotional base as long as it creates the possibility to open themselves to physical and social world with confidence, and as it acts as a facilitator of cognitive development. For this reason, if the family cannot ensure such base, social services are forced to resort to foster care, a resource that has a lot of difficulties, leading to different implications in the development of the child and of the foster family. It is therefore important to analyze in depth the socio-emotional variables that characterize children who are in a situation of foster care in order to provide adequate assistance to optimize their development. For this 32 minors in foster care, 31 foster parents and 28 teachers from the city of Valencia, were administered the BASC. The results highlight that parents are evaluating children, in general, worse than tutors. Specifically they consider children more aggressive, they detect more behavioral and attention problems and recognize in them a greater tendency to externalize the problems, while the teachers consider these children as with more social and adaptive skills. There were no significant differences between the scores of parents, teachers and children. High levels of psychopathology (which are clinically significant in various cases) and the fact that host parents evaluate minors as more problematic, are indicators of parents' and minors' need of support from public organizations.     

Representations of homelessness,home environments,and authority in the context of runaway behaviors reported by foster care youth residing in an emergency shelter

Between 31 and 46% of youth with histories of foster care placement were homeless at least once. Studies of the incidence of runaway behavior have identified a host of risk factors associated with running away from foster care placement, but less is known about the internalized processes of these individuals at risk for running away or the contextual experience surrounding it. This study is designed to investigate the representations made by individuals who have engaged in running away to uncover and explore thematic patterns. Accordingly, a secondary analysis was performed on data from four group interviews (n?=?15) collected from youth under the care of one child protective services (CPS) agency-operated emergency shelter setting, using thematic content analysis by two independent reviewers. Codes were networked and themes that emerged were discussed through a framework of power dynamics. Themes around the participants’ perceptions of homelessness, lack of control, and their resistance to authority were all identified as contributory to the theme of running away. The act of running away is, therefore, framed as a threshold event representing a multifaceted phenomenon combining perceptions of self-identity, conflict, and power in the home.     

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.     

The language and policy of care and parenting: Understanding the uncertainty about key players’ roles in foster care provision

Recent debates about the care provided to looked-after children have been characterised by uncertainty about the differing roles and responsibilities of foster carers, birth parents, and social workers. To explore the assumptions underlying these uncertainties, we drew upon Foucauldian Discourse Analysis and compared the discourses used by professionals (social workers in a group discussion about foster placement breakdown) with those used by policy-makers (in the Governmental green paper ‘Care Matters’). In both cases, a discourse based upon Attachment Theory was used to explain why placements succeed and fail, and to predict the repercussions of failure. However, there was a key difference in the way that professionals and policy-makers constructed the roles of key players in foster placements. The social workers constructed the birth parents as the parental figures for children in care, constructing themselves in a non-parental role. ‘Care Matters’ largely ignores the role of birth parents, and instead constructs social workers as parental figures. Neither source viewed foster carers as parental and ‘Care Matters’ positions this group as strictly professional. We discuss the incongruence of foster placements being understood through Attachment Theory, while foster carers are understood as non-parental figures, and also the repercussions of labelling a social worker as a parent, and the professionalization of the role of the foster carer.     

Foster care in India: An exploratory survey of the community perceptions and prospects for implementation of foster care in a developing nation: A study in Udaipur,Rajasthan, India

This study was conducted in order to assess the prospects for implementing foster care as an alternative to the dominant system of institutional care available to orphaned and abandoned children in India. 653 families in urban Udaipur participated in a mixed-methods based assessment of receptivity to foster and adoptive care. The majority of those who responded reported receptivity to the idea of foster care as an alternative to institutional care. However, analyses demonstrated that respondents also perceived barriers to implementing systematic foster care, particularly with regard to family recruitment due to problems securing family and community support for participation. The results are discussed in light of governmental calls for non-governmental organization and other stakeholders to institute alternatives to foster and adoptive care. The results of this study have applied significance for organizations and practitioners seeking to implement care alternatives for orphan and abandoned children in India.     

Comparing the effectiveness of behavioral interventions in adults with co-occurring tobacco and substance use disorders: a systematic review of literature

ABSTRACT

This systematic literature review compares the e?ectiveness of various behavioral interventions delivered to persons with co-occurring tobacco and substance use disorders. It examines ?ndings of six randomized trials and three secondary analyses from randomized trials. Based on the ?ndings of this literature review, support is given to the following: (1) The consequences of tobacco use and smoking are deadly, costly, and can have an inhibitory e?ect on the progress of people in substance abuse treatment, (2) tobacco cessation options are a preventive intervention that can be easily incorporated into a treatment facility’s standard of practice and should be made available within the context of all substance abuse treatment facilities, and (3) concurrently treating tobacco use disorder and substance use disorder(s) is an e?ort that will help meet the social work profession’s Grand Challenge to ‘Close the Health Gap.’     

A content analysis of sexual health and substance use information presented on study abroad websites: Findings and recommendations

Abstract

Objective: Despite study abroad students frequently engaging in risky behaviors, there is a dearth of research exploring prevention efforts taken by study abroad programs. The goal of this project was to examine information presented on study abroad program websites regarding sexual assault, alcohol use, drug use, and risky sexual behavior. Participants: A total of 753 universities in the US were selected from the Carnegie Classification of Institutes database. Method: Coders evaluated the website of each institution’s study abroad program for the presence of information about the four factors of interest. Results: Sixty-seven percent of the websites provided no information on any of these risk behaviors. Chi-square analyses revealed institutional demographic differences in the presentation of prevention information. We also identified three emerging themes about avenues for modifying website content. Conclusion: Study abroad programs can provide more detail and action oriented information on their websites for students.     

A comparison of simple score and latent class approaches: application to HIV knowledge data in Chinese and multi-country contexts

Knowledge about different health-related attitudes, beliefs, and risks is of significant interest to scholars in different Social Science disciplines. Usually knowledge is collected in a form of multiple variables and then constructed as a composite indicator. The question any researcher working with knowledge-related variables faces is: what is the best way to measure and summarise different dimensions of health-related knowledge? The main goal of this paper is to evaluate and compare simple score and latent class approaches to measuring and summarising health-related knowledge using population data on HIV knowledge collected in five selected countries (China, India, Kenya, Malawi, and Ukraine). The advantages and shortcomings of both approaches (simple score and latent class approaches) to measuring and summarising health-related knowledge are evaluated and discussed.     

Serving families with child maltreatment and substance use disorders: A decade of learning

ABSTRACT

An increase in parental substance use disorders (SUD) and the number of infants and toddlers entering foster care has prompted federal and state efforts to change the treatment paradigm toward more integrated and family-centered strategies. The Regional Partnership Grant (RPG) program demonstrated that family-centered strategies can improve child and parent outcomes. The current challenge is to bring effective strategies to scale. This conceptual article highlights the lessons learned from 10 years of implementing and evaluating programs to meet the needs of families affected by parental SUD and child maltreatment. Effective family-centered strategies identified by the RPG program are illustrated with specifics from the Sobriety Treatment and Recovery Team program. These effective strategies could be implemented in any jurisdiction and include (1) collaboration toward integrated services between child welfare and SUD treatment, (2) timely access to SUDS treatment, (3) recovery management and support, (4) tailored family services, and (5) adaptation to local jurisdiction needs. When these strategies are operational, children are more likely to be safe and remain in parent custody, and parents are more likely to achieve sobriety and improve their parental capacity. Future research might examine the unique impact of each of the five strategies independently.     

Temporal stability of entries and predictors for entry into out-of-home care before the third birthday: A Danish population-based study of entries from 1981 to 2008

Objective

Placing a child in out-of-home care is one of the most radical measures a child protection system can decide to take. There is an essential interest in understanding the probability of entering care and what circumstances are related to the decision to place a child in out-of-home care. This study investigates the temporal stability of rates and predictors for entry into care.

Method

Data were obtained by linking several registration systems. The study population was defined as all children entering care before their third birthday from birth cohorts 1981–2008 (N = 11,034). Furthermore, a control population consisting of a randomly assigned quarter of the Danish child population from the same birth cohorts was used (N = 515,773). Rates of entry and Cox regression models from six periods from 1981 to 2008 were used to model co-variates associated with entry into out-of-home care.

Results

The overall likelihood for entering care is found to be decreasing over time. Furthermore, results reveal two trends: relative rates of entry are significantly decreasing for children whose mother has a psychiatric history prior to the child's birth; relative rates are significantly increasing for children whose mother or father was unemployed in the year prior to the child's birth.     

Children placed in long-term family foster care: A longitudinal study into the development of problem behavior and associated factors

Due to prior experiences of trauma and abuse, many foster children have behavioral problems. The placement of the child in a family foster home is expected to reduce the behavioral problems. However, this expectation is seldom met and mostly behavioral problems increase or remain stable during placement. Research on the development of behavioral problems in foster children is scarce. Moreover, most of the research results are situated on a group level, which obscures the development of problem behavior on a case level. This study investigated the development of problem behavior of 49 foster children on a case level and the association of global, contextual, familial and child factors with the increase or decrease of problem behavior. Over a two year period 18 foster children had more, 23 just as much and 8 less problem behavior. An increase was associated with the use of more negative parenting strategies by the foster mothers. A decrease was related to the use of supportive parenting. Support of foster parents aiming at reducing the use of negative discipline practices and promoting the use of supportive parenting may have a positive effect on the development of foster children.     

A three-city comparison of drug use and drug use before sex among young men who have sex with men in the United States

High rates of drug use have been documented among young men who have sex with men (YMSM). However, updated prevalence data are needed to understand current trends, especially for drug use before sex. We used baseline data from an HIV prevention trial to examine demographic differences in drug use and drug use before sex among YMSM in Atlanta, Chicago, and New York City. Marijuana was the most commonly used drug, but alkyl nitrites (“poppers”), cocaine, and Ecstasy were also commonly used. Drug use was more prevalent among older and White YMSM, and it was similar across cities, although use of poppers and polydrug use were more common in New York City. Our data generally support national prevention efforts.     

Bullying victimization,negative emotions,and substance use: utilizing general strain theory to examine the undesirable outcomes of childhood bullying victimization in adolescence and young adulthood

Bullying victimization has been directly associated with a variety of negative outcomes, but there are still many unknowns as to how deleterious emotional states resulting from victimization influence other undesirable events. The current study draws on Agnew’s general strain theory to examine multiple outcomes of youth victimized by repeated bullying prior to adolescence. Data from the National Longitudinal Survey of Youth 1997 were used to examine indicators of diminished moods and negative emotions on substance use for bullying victims in adolescence and again during young adulthood. Findings from various LISERL models indicate that bullying victimization directly increases diminished moods for males and females in adolescence. Additionally, childhood bullying victimization directly increases substance use in adolescence and young adulthood for males but not females. Finally, diminished moods in adolescence and negative emotions in young adulthood increase substance use for females but not for males. Policy implications and limitations for this analysis are discussed.     

The Assessment Checklist for Adolescents — ACA: A scale for measuring the mental health of young people in foster,kinship, residential and adoptive care

The Assessment Checklist for Adolescents — ACA is a 105-item carer-report mental health rating scale, measuring behaviours, emotional states, traits, and manners of relating to others, as manifested by adolescents (ages 12 to 17) residing in various types of alternate care, as well as those adopted from care. The ACA was designed for population and clinical research with these young people, and for use as a clinical assessment measure. The ACA's content was largely derived from the Assessment Checklist for Children (ACC). Fifteen ACC items were modified to better reflect adolescent difficulties, and 25 additional items were derived using a combination of inductive and deductive strategies. Item and factor analyses were carried out on scores from a 136-item research instrument, obtained for 230 young people residing in long-term care (as part of the NSW Children in Care study). These data were supplemented by ACC scores obtained for 142 adolescents residing in treatment foster care in Ontario, Canada. A robust 7-factor model was identified among a core of 73 clinical item scores, accounting for 51% of score variance. Four of the factors replicate ACC clinical scales (non-reciprocal interpersonal behaviour; sexual behaviour problems; food maintenance behaviour; and suicide discourse), and three are unique to the ACA (social instability/behavioural dysregulation; emotional dysregulation/distorted social cognition; and dissociation/trauma symptoms). The ACA also contains two empirically-derived low self-esteem scales (low confidence; negative self-image) that are shared with the ACC. Initial data indicate that the ACA has good content, construct and criterion-related validity, as well as high internal reliability.