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

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

Children in out-of-home care as young adults: A systematic review of outcomes in the Nordic countries

BackgroundInternationally, the Nordic countries occupy top positions in child well-being. We investigated literature on the overall outcomes of young adults from the most vulnerable backgrounds in the Nordic countries, namely young adults who were placed in statutory out-of-home care (OoHC, i.e. foster care) during childhood in the Nordic countries for the protection of their safety and welfare.MethodsWe followed PRISMA guidelines and conducted literature searches manually, as well as electronically, via EBSCO's Psychology/Sociology databases and ProQuest's Social and Behavioral Sciences databases in February 2016 for quantitative studies that compared outcomes at age 18 or later between young adults placed in OoHC as children and those never placed in OoHC. Because of the heterogeneity and small number of eligible studies on each outcome, we conducted no meta-analysis but did formulate a narrative synthesis.ResultsOf 333 studies identified, 20 met the inclusion criteria. All of these studies were cohort studies that employed social and health register data. OoHC placement was studied with nine outcome categories: self-supporting problems, educational challenges, mental health problems, criminality, teenage parenthood, mortality, suicidal behavior, alcohol and drug use, and disability pension. In each of these categories, young adults with a history in OoHC faced higher risks compared with the general population, even after adjusting for various birth parents' socio-economic, demographic, and mental health–related factors.ConclusionAlthough the Nordic countries are among the world's leading nations in promoting child well-being, the Nordic welfare model has partly failed in preventing the inequality of families with children. As young adults, children placed in OoHC in the Nordic countries face an elevated risk of experiencing adversity.     

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.     

A bit more understanding: Young adults' views of mental health services in care in Ireland

Children and young people in the care system typically experience very high levels of mental health difficulties, yet their views of these difficulties and of mental health services have rarely been explored. For this qualitative study we spoke with eight young adults aged 18 to 27 years with experience of the care system in Ireland about mental health challenges, service experiences, and how they felt mental health services needed to improve. Themes from the interviews illuminated young adults' views of their emotional well-being while in care, and the double stigma of being in care and mental health difficulties. In terms of services, young adults wanted these to be flexible and sensitive to level of need; to offer choice and more congenial environments; to provide more creative routes to engaging young people; and to offer honest, reciprocal, caring communication — treating children in care as one would any child. Recommendations highlight three key needs: an ethic of care in services as well as an ethic of justice; mental health training for all professionals in contact with children in care; and the need to listen, hear and act on what children and young people say.     

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.     

Interprofessional collaboration between residential child care and mental care practitioners: a cross-country study in six European countries

ABSTRACT

The severe mental health problems of many of the young people living in residential settings pose a great challenge and demand on child protection and mental care (MC) services. Drawing on comparative research and debates from six European countries, this study examines demands for integrated care and interprofessional collaboration practices between residential child care (RCC) and MC. In this article, research data will be brought together from Denmark, Finland, Germany, Lithuania, the UK (Scotland) and Spain. In total, 61 practitioners from RCC and MC were interviewed. Given the complexity of the residential care service context and service system differences across national contexts, the original hypothesis was that this would differentiate the collaboration practices. However, the similarity between the countries is greater than anticipated. The concluding findings are organised by matrix technique into a content-analytic summary table. The main finding was that in spite of encouragement for integrated RCC, obstacles for collaboration and lack of coordination between systems remain, often related to understanding the professional role and tasks, lack of shared knowledge, attitudes and ways of communication. One significant finding in the cross-country comparison was the evident and unrealistic expectations for the ‘other’ provider to help and care.     

Externalizing problems in young foster children: Prevalence rates,predictors and service use

Objective

Examining the prevalence of externalizing problems, their predictors and mental health service use for these problems by foster children and foster parents in a representative group of foster children aged 3 to 12 in Flanders.

Method

Survey data were collected on 212 foster children, who had been in the foster family for approximately four months. Foster parents filled out a Child Behavior Checklist to measure foster children's externalizing problems. Foster care workers reported on several potential risk variables for externalizing problems and on foster children's and foster parent's mental health service use. Predictors of externalizing problems were identified from a large number of variables using the method of purposeful selection of variables in linear regression.

Results

40.6% of the foster children had externalizing problems. Foster children who were placed because of behavioral problems had more externalizing problems. Only 20.9% of the foster children with externalizing problems and only 13.9% of their foster parents received professional help.

Conclusions

This study showed that externalizing problems are prevalent in this young foster care population, that it is hard to predict which foster children had externalizing problems, and that foster children and their foster parents rarely receive services for these problems. These findings call for a standard protocol of assessment of foster children's externalizing problems. Moreover, from a preventive viewpoint, guidelines are needed to systematically link young foster children with externalizing problems and their foster parents to appropriate services.     

Evolve Therapeutic Services: A 5-year outcome study of children and young people in out-of-home care with complex and extreme behavioural and mental health problems

BackgroundLittle evaluation research has been conducted on the effectiveness of services and intervention provided to children in out-of-home care. This study evaluated an innovative Queensland, Australia program employing a collaborative wrap-round model of care in combination with a flexible intervention approach, individually tailored to children and young people in out-of-home care presenting with complex and extreme behavioural and mental health problems.MethodThe sample consisted of 664 children and young people. Two clinician-rated measures, the CGAS and HoNOSCA, were used to assess young people's functioning via a pre-post-treatment design.ResultsResults revealed significant improvements across a range of problems areas: general functioning and adjustment; disruptive, antisocial and aggressive behaviour; overactivity, poor attention and concentration; non-accidental self-injury; problems with scholastic and language skills; non-organic somatic symptoms; emotional symptoms; peer and family relationships; self-care and independence; and school attendance.ConclusionFindings provide good evidence for the effectiveness of the therapeutic intervention program. Implications for future research are explored.     

Independent living programs for young people leaving the care system: The state of the evidence

A substantial body of evidence suggests that young people leaving public care systems are at increased risk for low educational attainment, unemployment, homelessness, physical and mental health difficulties, dependency on public assistance, and involvement with the criminal justice system. Independent living programs (ILPs), which incorporate life skills and personal development, are one strategy frequently used to improve outcomes for young people leaving care. However, the effectiveness of ILPs remains unknown. This paper systematically reviews the current evidence for ILPs, summarizing all controlled comparisons designed to evaluate their effectiveness. Reviewers were unable to find any randomized controlled trial evaluating ILPs, but the results of eight non-randomized controlled studies suggest that some ILPs may have protective effects for youth leaving the public care system. These trends were observed for outcomes related to educational attainment, employment, housing, health, and other life skills; nevertheless, the weak methodological quality of the evidence tempers the validity and generalizability of these conclusions. Further research utilizing random assignment of participants is imperative in order to draw reliable conclusions for policy and practice.     

Collaborative care for individuals with bipolar disorder or schizophrenia and co-occurring physical health conditions: A systematic review

While rates of chronic physical health conditions are increasing for the general population, individuals with severe mental illness are at greater risk. Co-occurring mental and physical health conditions are associated with poor health care utilization, socioeconomic, and patient-reported health status outcomes. This study used systematic review procedures to investigate the effectiveness of collaborative care models for improving the health of adults with bipolar disorder or schizophrenia and co-occurring chronic physical health conditions. Six studies met inclusion criteria, and included outcomes related to quality of life, physical health, and mental health. Collective and study-level results are reported and discussed, including implications for social work practice and research.     

From dependence to interdependence: towards better outcomes for young people leaving state care

Young people leaving out of home care are arguably one of the most vulnerable and disadvantaged groups in society. Compared to most young people, they face particular difficulties in accessing educational, employment, housing and other developmental and transitional opportunities. Care leavers have been found to experience significant health, social and educational deficits including homelessness, involvement in juvenile crime and prostitution, mental and physical health problems, poor educational and employment outcomes, inadequate social support systems and early parenthood. These poor outcomes reflect a number of factors including ongoing emotional trauma resulting from experiences of abuse and neglect prior to care, inadequate support while in care, accelerated transitions to adulthood and lack of guaranteed ongoing financial and other assistance to help facilitate this transition. Young people leaving care do not currently receive the ongoing support that a good parent would be expected to provide for their children. Using relevant literature from the USA, UK and Australia, this paper examines the factors that contribute to these poor outcomes and potential policy and practice reforms that may lead to better outcomes for care leavers. Copyright © 2006 John Wiley & Sons, Ltd.     

Agency among young people in marginalised positions: towards a better understanding of mental health problems

ABSTRACT

Agency in marginalised youth has been studied from various perspectives, yet the challenges that mental health problems pose for their agency remain poorly understood. Drawing on data from a study on youth transitions fractured by mental health problems, this study sheds light on this important issue. The data consists of 49 life story interviews with young adults. Using Ruth Lister’s four-dimensional taxonomy of agency, the analysis shows how everyday struggles with mental distress are entangled with the practices of the social security system, medical care, education, labour markets, and work life. It also reveals how emerging attempts at strategic agency can fail or flourish depending on the response of the social and structural context. If strategic agency is restricted by institutional practices, it will soon return to day-to-day struggling or become everyday resistance and cynicism towards the system. However, if the strategic agency is supported by institutional practices, a genuine path out of distress emerges. The paper suggests that taking seriously the experiences of mental distress and situating them in a specific socio-political context is essential for understanding youth agency today.     

Population aging and long-term care policies in the Gulf region: a case study of Oman

Population aging is a phenomenon occurring across the globe including in countries traditionally exhibiting population dividends and “youth bulges.” The Gulf Corporation Council countries are no exception as they currently experience a process of population aging, albeit at a different stage from many developed countries. However, due to historically high fertility rates and fast-paced epidemiological transition, some of these countries will experience population aging at a higher pace than what has been observed in Europe and the United States. This article reviews recent developments in long-term care policies in the Gulf region with a focus on Oman as an example of a high-income Arab country that is experiencing population aging while still being governed by traditional family aged-care norms. Utilizing existing data and published research complemented by policy analysis and field visits, we analyze the process of population aging in Oman and neighboring countries and its policy implications.     

Caring for older adults with bipolar disorder

Bipolar disorder is a recurrent, chronic mental illness that has a profound impact on the lives of patients and their families and may require extensive use of mental health services. Although bipolar disorder is often considered an illness of young people, the disorder is being recognized as more common in older adults than previously thought. Much more research needs to be done to understand the impact of aging on the course and treatment of bipolar disorder. Evidence-based interventions for treatment of this disorder in older adults must be developed. Mental health nurses can play a key role in enhancing medication adherence, implementing structured psychosocial interventions, and carrying out research to enhance diagnosis and treatment of older adults with bipolar disorder.     

The subjective well-being of young people aging out of care

This study explores the subjective well-being (SWB) of young people aging out of public care in Israel, identifying the individual, social support and institutional characteristics of young people on the verge of leaving care that predict their SWB one year later. The results were obtained from two waves of a longitudinal study with young people who aged out from residential settings in Israel. Shortly before they left care 272 young people completed a self-administered questionnaire and 234 of them were interviewed a year later. Overall, their SWB was fairly positive. Specifically, positive relationship with the mother contributes to a better SWB, and learning difficulties reduced SWB. Gender and country of origin also showed a significant effect. The findings highlight the importance of strengthening the young people's relationships with their biological parents while in care and emphasize the need to provide additional support for those with learning difficulties. The findings also help identify sub-groups of young people in care with greater need for support both while in care and afterwards.     

Care-leavers and their children placed for adoption

Young people in and leaving state care are more likely than the general population to become parents at a young age. Relatively little is known about the experiences and progress of care leaver parents and their children, but emerging evidence suggests an increased risk of intergenerational state intervention. Drawing on data from the Wales Adoption Study, this paper examines the prevalence and profiles of care leavers amongst birth parents whose children were placed for adoption. Findings showed that more than a quarter (27%) of birth mothers and a fifth (19%) of birth fathers with children placed for adoption were themselves care leavers. There were no significant differences between care leaver and non-care leaver birth parents in terms of involvement in crime or substance misuse, but carer leaver birth parents were distinguishable from other birth parents by their own experiences of abuse and neglect. Care leaver birth mothers were also more likely than their non-care leaver counterparts to have diagnosed mental health problems and were less likely to appeal the adoption plan. The profiles of children placed for adoption between care leaver and non-care leaver birth parents were similar. The findings presented in this paper strengthen the moral imperative to address the over-representation of care leavers amongst birth parents whose children are placed for adoption. There is an urgent need to revise how children and young people in state care are prepared for parenthood and supported as parents.     

Mental health and aging in the 21st century

This article reviews pressing issues in mental health care for older adults in the 21st century. After examining current forces for change in older adults' mental health care and coverage, the authors discuss barriers to accessing mental health care resulting from the fragmentation of the United States health care system as well as the history behind the multiple and competing systems of care for older adults. The article continues with a discussion of goals for the provision of good mental health service delivery for older adults and concludes by addressing potential responses and future target areas regarding mental health care for older adults as well as a potential realistic collaboration to address mental health and aging.     

“I'm still raring to go”: Successful aging among lesbian,gay, bisexual,and transgender older adults

While we know that minority status differentiates the experience of aging, little research has been done to examine the ways in which patterns of successful aging may differ in diverse subgroups of older adults. In this exploratory study, we investigated and described experiences of successful aging in a sample of lesbian, gay, bisexual and transgender (LGBT) older adults. Directed by a community-based participatory research process, we conducted semi-structured in-depth interviews with 22 LGBT adults, age 60 and older. We took an inductive, grounded theory approach to analyze the taped and transcribed interviews. We coded respondent experiences in four domains: physical health, mental health, emotional state and social engagement. Four gradations of successful aging emerged. Very few in our sample met the bar for “traditional success” characterized by the absence of problems in all four domains of health. Most of the sample was coping to a degree with problems and was categorized in one of two gradations on a continuum of successful aging: “surviving and thriving” and “working at it.” A small number was “ailing”: not coping well with problems. Some of the experiences that respondents described were related to LGBT status; others were related to more general processes of aging. The research suggests that a successful aging framework that is modified to include coping can better describe the experiences of LGBT older adults. The modified conceptual model outlined here may be useful in future research on this population, as well as more broadly for diverse populations of adults, and may be adapted for use in practice to assess and improve health and well-being.     

Establishing a mental health service for young children in out-of-home care: The Gumnut Clinic for 0 to 5 year olds in Western Sydney

Objective

Children aged 0 to 5 years in out-of-home care represent a vulnerable population at high risk of social, emotional and developmental problems, yet there are few services specifically addressing their psychological needs. This paper is the first of two concerning the establishment of The Gumnut Clinic, a specialist mental health assessment clinic in Western Sydney for this population. The current paper provides the rationale for the development of the clinic and detail of the referral and assessment processes.

Method

The paper describes the establishment of The Gumnut Clinic at Redbank House in Sydney, Australia, the approach to assessment of these young children and their carers, and the challenges encountered.

Conclusions

Young children are overrepresented in child protection and out-of-home care services. Their social, emotional and developmental needs are under-recognized. Development of a specialist mental health service is a step towards improving health outcomes for these children.