Health and mental health services for children in foster care: the central role of foster parents

It is well documented that children enter foster care with special health and mental health needs and, while in care, those conditions are often exacerbated. However, less attention has been given to foster parents who have the most contact with these children. Results are presented from a national study on the developmental, health and mental health care needs of children in foster care that included foster parents' perspectives and observations. Their role in improving child well being is explained and recommendations for policy, practice and advocacy also are included.     

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.     

The moderating effect between strengths and placement on children's needs in out-of-home care: A follow-up study

The negative impact of childhood maltreatment, which can often extend well into adulthood, consistently appears to be ameliorated if victimized children possess several resiliencies or strengths. However, little is known about how vulnerable children's outcomes are affected by different levels of strengths across different out-of-home placement settings. Hence, this study examined the association of two factors — children's strengths and placement type, with outcomes at two time-points during out-of-home care. The Child and Adolescent Needs and Strengths (CANS) tool was used to assess the outcomes of 285 children placed in residential homes or foster care in Singapore. Multiple regressions were conducted on CANS domain scores to evaluate whether level of baseline strengths and placement type predicted outcomes at two time-points after controlling for race, prior placements, age, gender, interpersonal trauma, and baseline needs scores. Results indicate that relative to residential care, foster care children are reported to be younger, with lower baseline needs, more prior placements, fewer baseline strengths and suffered fewer types of interpersonal trauma. After controlling for covariates, higher baseline strengths significantly predicted lower baseline needs of children across 3 of 4 CANS domains, regardless of placement settings. However, at reassessment 1 year later, there were significant interactions between strengths and placement type, whereby baseline strengths significantly predicted lower life functioning needs only in foster care. To conclude, in both residential and foster care, the protective effects of high strengths against child maltreatment were similarly apparent at baseline, despite clear differences in children's profiles across placement types. Over time, these initial benefits appeared to persist somewhat for children in foster care but seemed to diminish in more restrictive, residential settings and this warrants further investigation on children with more similar profiles. Nonetheless, it is clear that the continual development of children's strengths should be prioritized in case planning.     

Behavioral health service use and costs among children in foster care

This article compares behavioral health service use and cost for foster care versus nonfoster care children; children before, during, and after foster care placement; and successfully reunified versus nonsuccessfully reunified foster care children. Behavioral health service costs for children in foster care were higher than for children not in foster care. Children in foster care used more services during their foster care placement than before placement and after discharge. Nonsuccessfully reunified children received a significantly larger quantity of services than those successfully reunified.     

Mental health interventions for children in foster care: A systematic review

Children in foster care have high rates of adverse childhood experiences and are at risk for mental health problems. These problems can be difficult to ameliorate, creating a need for rigorous intervention research. Previous research suggests that intervening with children in foster care can be challenging for several reasons, including the severity and complexity of their mental health problems, and challenges engaging this often transitory population in mental health services. The goal of this article was to systematically review the intervention research that has been conducted with children in foster care, and to identify future research directions. This review was conducted on mental health interventions for children, ages 0 to 12, in foster care, using ERIC, CINAHL, PsycINFO, PubMed, ProQuest's Dissertation and Theses Database, Social Services Abstracts, and Social Work Abstracts. It was restricted to interventions that are at least “possibly efficacious” (i.e., supported by evidence from at least one randomized controlled trial). Studies were evaluated for risk of bias. Ten interventions were identified, with diverse outcomes, including mental health and physiological. Six interventions were developed for children in foster care. Interventions not developed for children in foster care were typically adapted to the foster context. Most interventions have yet to be rigorously evaluated in community-based settings with children in foster care. Little research has been conducted on child and family engagement within these interventions, and there is a need for more research on moderators of intervention outcomes and subgroups that benefit most from these interventions. In addition, there is no consensus regarding how to adapt interventions to this population. Future research should focus on developing and testing more interventions with this population, rigorously evaluating their effectiveness in community-based settings, determining necessary adaptations, and identifying which interventions work best for whom.     

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.     

Mental health service utilization and time to care: A comparison of children in traditional foster care and children in kinship care

Existing research indicates that children who are involved with the child welfare system and placed in various forms of out-of-home care experience emotional and behavioral problems. It is also suggested that children placed in kinship care are less likely to receive mental health services than children placed in non-kinship foster homes. This study sought to compare children in non-kinship foster homes to children in kinship care to determine their receipt of mental health services and the time it took for children in kinship care to receive mental health services compared to children in non-kinship foster homes. Using a Cox regression, researchers determined that children in kinship care had a 14% lower likelihood of receipt of mental health services compared to their counterparts in non-kinship foster placements.     

Abused children and foster care—the need for specialist resources

Estimates vary on how many abused and neglected children are admitted to care and how many children in care are there because of abuse and neglect. Nevertheless, it is important to examine their special needs and the problems they present to carers. Although research findings are difficult to interpret, there is enough evidence to show that abused and neglected children in care have special needs in three particular areas: education, health and social behaviour. The evidence is available from research into children in care and research into child maltreatment. Children in care run the risk of disrupted educational careers; abused and neglected children have additional problems in school. Many children in care have a patchy and neglected medical history; abused and neglected children are seriously at risk of further ill-health. Abused and neglected children have been shown to have behaviour problems that jeopardize their relationships with peers and adults; they run the risk of placement breakdown. Foster care of abused and neglected children is a specialist and demanding task, requiring knowledge of, and sensitivity to special needs. Because many abused and neglected children return to their parents, foster carers also need to include the natural family in their task. High expectations of these foster carers, however, should not lead to exploitation but rather an enhancing of fostering assessment, preparation, support and training.     

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.     

Child-related dimensions of placement stability in treatment foster care

Research shows increasing numbers of emotionally disturbed children entering foster care nationwide. As a result, there is growing interest in a special form of foster care known as therapeutic or treatment foster care. However, little information is currently available on the kinds of children who can benefit from this form of mental health care or on interactions between child characteristics and placement outcome. This paper begins to address this deficit in the knowledge base by proposing five psychosoical dimensions of child functioning associated with placement stability and outcome in treatment foster care. Current theory and research regarding each dimension are presented along with clinical examples.     

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.     

Comparing the health status of low-income children in and out of foster care

Children in foster care face poverty, family dysfunction, neglect, and abuse, with high rates of chronic health, emotional, and developmental problems. This study compared the overall health status of a group of children entering foster care with a group of Medicaid-eligible children living with their parents, matched for age and gender. It identified significantly more health and developmental problems in children in foster care than in the comparison group. Possible contributors to the higher percentage of problems among foster care children may be that the foster children have more problems related to the underlying risk factors resulting in placement, or that the foster care physicians conducted a more comprehensive assessment or had lower clinical thresholds. Further research is necessary to identify and treat the problems of this high-risk group.     

Needs assessment of youths in residential child care in Portugal / Evaluación de necesidades de jóvenes en acogimiento residencial en Portugal / Evaluación de necesidades de jóvenes en acogimiento residencial en Portugal

Residential child care in Portugal is the most common protection measure in cases of family separation, since family foster care is still very rare. However, little is known about the needs of these children and young people. The purpose of this study is to describe the profile of adolescents close to legal adulthood who are in residential care, comparing it with a Spanish sample. The sample is composed of 345 young people aged 16 to 17 on whom information has been collected regarding their history of protection, family background, schooling, mental health and offending behaviour. A Spanish sample was selected as a comparison group (N = 384). The results reveal the complexity and special seriousness of the profile of young people in residential care in Portugal compared to a Spanish sample, highlighting a high presence of mental health problems and especially suicidal behaviours. Given these results, efforts should be focused on developing specialized residential care programmes adapted to the specific needs of these young people.     

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.     

Mental health service utilization in children adopted from US foster care,US private agencies and foreign countries: Data from the 2007 National Survey of Adoption Parents (NSAP)

Aims

In this analysis, we (1) described the rate of mental health service utilization for children from domestic foster care adoption, domestic private adoption, and international adoption and (2) analyzed the effect of common risk factors on mental health service utilization.

Data

As part of the 2007 National Survey on Adoptive Parents (NSAP), parents with children 5–17 years old (N = 1722) were asked if their children had received mental health services and how helpful these services were. Parents also provided data on the children's demographics and likelihood of pre-adoption adversity (e.g., abuse).

Results

For boys, mental health services were utilized by 52.4% of domestic foster care adoptees, 41.0% domestic private adoptees, and 40.0% of international adoptees. For girls, the corresponding rates were 36.3%, 24.8%, and 30.9% respectively. Parents reported that the services were very helpful for about half of the children. Logistic regression analyses showed that adoptees from domestic foster care were more likely than international adoptees to have received mental health services, but there was no difference between domestic private adoptees and international adoptees. Older age at placement, older age at assessment, having special health care needs, and being male all increased the odds for having received mental health services.     

A comparison of outcomes for children and youth in foster and residential group care across agencies

Working collaboratively with two state associations and their member (nonprofit) agencies providing out-of-home care to children and youth, University researchers conducted a multi-site project to examine whether there were any differences in individual child-level outcomes between children placed in residential group care and those placed in foster. The study employed a quasi-experimental repeated measures design, with data collected at a minimum of two intervals (at intake and 3-month follow-up) and at subsequent intervals of 6 and 12 months for children remaining in care. Samples for analyses were drawn from 1082 youth in either residential group care (n = 903) or foster care (n = 179), in one of 37 agency sites across two southeastern states, who participated in a broader evaluation project. The average ages of participating youth in residential and foster care were 13.97 (SD = 2.43) and 13.65 (SD = 2.73), respectively. Based on his or her score on the Children's Global Assessment Scale (CGAS) at intake, each participant was also assigned to the low functioning group (n = 526; 53.1%), the borderline group (n = 232; 23.4%), or the high functioning group (n = 232; 23.4%). Analyses confirmed that youth in foster care tended to have higher levels of general functioning at baseline than did youth placed in group care. However, the degree to which youth progressed in care on measures of general functioning and mental and behavioral health problems did not differ based on placement setting; youth in residential group care settings progressed at the same rate as youth in community-based settings, regardless of their level of functioning at intake. The only exception to this pattern was in regard to anxiety; there was an observable, but non-significant trend of youth in foster care reporting decreases in anxiety levels, while those in group care reported increased anxiety.     

A Review of Peters,S. F. (2008). When prayer fails: Faith healing,children, and the law.

Sibling relationships are an important, yet underinvestigated dimension of foster care research. Despite the fact that a majority of children in care have brothers or sisters, only recently have child welfare researchers begun to explore the complex and dynamic nature of sibling relationships in substitute care settings. Although cross-sectional and longitudinal studies suggest differences in stability and permanency outcomes for siblings placed together versus those placed separately, exactly how and under what conditions do sibling relationships positively influence placement stability, permanency, and well-being in foster care settings remains unknown. This article provides a substantive review of the research on sibling foster care, placement stability, and well-being; identifies two theoretical frameworks that may be particularly useful to help explain the intersection of these constructs; and proposes a multilevel conceptual model for advancing research and practice with siblings in foster care.     

Preparing parents for children with special needs: A three-part approach

This paper describes a community-based educative-small group method for working with prospective foster and adoptive parents. As an educational approach, the program prepares applicants to be substitute parents. The small group process method provides the applicants with an atmosphere conducive to discussing fears and frustrations while gaining peer and professional support. Community-centeredness not only allows the agency to recruit much-needed minority parents, but to make a contribution to the community in the form of prevention of problems through availability and education. Evaluation of the program demonstrates that the combined communitybased, small group approach is an effective and efficient method for “screening-in” foster and adoptive parents for children with special needs.     

Family life education for day care programs serving the black community

The increase in working mothers has led to a growing demand for day care cross-culturally. Attitudes and opinions vary in regard to the necessity of parental involvement in these programs. However, to foster development of the “whole” child, meaningful and shared communication must exist between the parents of preschool children and their caretakers. The Family Life Education discussion ρoup is a form of social work intervention developed around the life tasks facing families and individuals. This article explores the use of such groups in conjunction with day care programs serving black children from low-income families.     

Infants in Foster Care

Abstract

This article highlights the importance of attachment issues for infants placed in foster care. We offer a framework for understanding how early separation and maltreatment may affect infants' ability to securely rely on a foster parent. We argue that disruptions in foster infants' primary attachment relationships, combined with a history of maltreatment, place these infants at risk for developing predominantly insecure or disorganized attachments to foster parents, regardless of foster parent characteristics. We argue that foster infants' successful passage through the foster care system requires a high level of foster parent sensitivity to their unique attachment needs. We also argue that this level of sensitivity is likely to require specialized training for foster parents.