Racial/Ethnic Disparities in Mental Health Service Use for Older Foster Youth and Foster Care Alumni

Studies have shown that foster care alumni have disproportionally high rates of poor mental health outcomes compared to the general population. The purpose of this study was to examine differences in mental health service use for Latino, African American, and White youth while in foster care and upon exit from the foster care system. Secondary data were used to identify youth 1 year prior to exiting the foster care system (N?=?934) and 1 year after exit from the foster care system (N?=?433). Racial/ethnic disparities in mental health service use upon exit from the foster care system were found, with Latino youth using the least amount of services after foster care exit. Racial/ethnic service disparities in type of services used were also found. Findings suggest that a lack of support (e.g., mandatory or voluntary) may be significant in overcoming challenges in the continuation or disruption of services.     

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.     

Sharing the Baton,Not Passing It: Collaboration between Public and Private Child Welfare Agencies to Reunify Families

ABSTRACT

Increasingly, public sector child welfare agencies are contracting with private agencies for the provision of specialized services to clients while maintaining oversight and case management responsibilities. At the same time, funders, both private and public, are demanding that service providers partner and collaborate with one another. In this article, we present results from a study of a unique partnership between two state child welfare agencies and a private child welfare agency aimed at reunifying families whose children have been removed and placed in foster care. Data was obtained from 41 key informants using a questionnaire and a structured interview. Findings support earlier studies of collaboration, and indicate the strengths of this partnership and factors that facilitated and hindered it. The results have implications for agencies that both contract for and provide a range of child welfare services as well as other interagency relationships.     

Transition from Foster Care to Independent Living: Ecological Predictors Associated with Outcomes

Nationally, the outcomes for youth aging out of foster care are dismal. Most children leaving foster care do not have the financial, medical, or social support tools necessary to bridge this transition successfully, placing a significant burden on youth leaving care (Courtney, Piliavin, Grogan, & Nesmith in Child Welfare 80:685–717, 2001; Kools & Kennedy in Pediatric Nursing 29(1):39–45, 2003; Simms, Dubowitz, & Szilagyi in Pediatrics 106:909–918, 2000). Given the poor outcomes for youth aging out of foster care, and the small body of literature on what works to improve outcomes, the purpose of this study was twofold. First to examine youth characteristics associated with better outcomes, and secondly to explore what program characteristics were correlated with outcomes. A causal comparative research design was used, employing pre-existing data. Records were collected from an agency in a large urban/suburban area in the State of Texas. Data was collected from both the Transition Resource Action Center (TRAC) and Children’s Protective Services databases. To determine outcomes, both TRAC’s Self-Sufficiency Matrix and case records were used. TRAC’s Self-Sufficiency Matrix has five domains: Education, Employment, Employability, Financial Literacy, and Shelter. t tests were used to examine differences in outcomes between youth who received TRAC services before and after leaving care. t tests were also used to examine changes in overall Self-Sufficiency Matrix scores. Furthermore, linear and stepwise regressions were conducted to determine which variables were predictive of scores on the Self-Sufficiency Matrix. The results of this study indicate that TRAC is having a positive influence on the youth receiving services. Youth show significant improvement across four of the five identified domains and maintained on the fifth domain, employment. Implications for research practice and policy are presented.     

Crisis nursery services and foster care prevention: An exploratory study

ObjectiveTo examine whether receiving crisis nursery services reduces the chances of subsequent placement of children into foster care.MethodThe study includes a sample of 322 children from the administrative data from a crisis nursery in Ohio. Generalized estimating equations analysis was conducted to assess the relationship between crisis nursery services (case management and parenting education) and subsequent foster care placement.ResultsThe generalized estimating equations analyses indicated that case management and parenting education provided from the crisis nursery were associated with reduced likelihood of subsequent foster care for children who were placed in the crisis nursery. Foster care placement during the previous 12 months and Caucasian race were also associated with higher odds of subsequent foster care placement.ConclusionsCrisis nursery services delivered with case management and parenting education may be an effecive intervention to reduce children's subsequent foster care placement.     

Achieving Permanence in Foster Care for Young Children: A Comparison of Kinship and Non-Kinship Placements

ABSTRACT

A number of child welfare policies have reinforced the use of kinship care as the most preferred placement for foster children, reflecting the philosophy that maintaining children within their own extended family system contributes to their stability and well-being. Given the growing utilization and legislative emphasis on kinship care along with the push for an immediate implementation of permanency plans for children in foster care, this study examines how the permanency goal under the 1997 Adoption and Safe Families Act (ASFA) is being implemented and achieved. The reunification and permanency placement (adoption or legal guardianship) outcomes of children in relative and non-relative care are analyzed, focusing on the experiences of young children. Based on public child welfare agency data from 2000 to 2003, child, case, and placement variables are explored to identify which set of factors best explains case outcomes. The present study identifies the total length of foster placement (kinship and non-kinship), the length of family maintenance services, and the number of placement changes as the most important variables in determining family reunification and permanent placement (legal guardianship and adoption) outcomes for young children.     

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

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

Cost effectiveness of a school readiness intervention for foster children

ObjectiveMany young children in foster care suffer from emotional and behavior problems due to neglect and abuse. These problems can lead to difficulties in school, and functioning in school is linked to long-term health and development. Early intervention to reduce emotional and behavioral issues can help children successfully transition to school, which can improve long-term outcomes. However, communities need information on relative costs and benefits associated with programs to make informed choices. The objective of this study was to assess cost effectiveness, over 12 months, of the Kids in Transition to School (KITS) intervention compared to usual services available to children in a foster care control group (FCC).MethodRandomized controlled trial of 192 children in foster care entering kindergarten who were randomized to KITS (n = 102) or FCC (n = 90). KITS includes school readiness groups and parent training over 4 months. Main outcomes were days free from internalizing symptoms (IFD), days free from externalizing behavior (EFD), intervention costs, public agency costs, and incremental cost effectiveness.ResultsKITS significantly increased IFD and EFD compared to FCC. Average total cost of the intervention was $932 per family. The intervention did not significantly impact usual services. Average incremental cost effectiveness was $64 per IFD and $63 per EFD.ConclusionsThe cost of KITS is comparable to, or less than, similar programs, and the intervention is likely to provide significant emotional and behavioral benefit and improvement in school readiness for young children in foster care.     

Nutritional status of foster children in the U.S.: Implications for cognitive and behavioral development

ObjectiveChildren in foster care are at greater risk for poor health, physical, cognitive, behavioral, and developmental outcomes than are children in the general population. Considerable research links early nutrition to later cognitive and behavioral outcomes. The aim of this narrative review is to examine the prevalence of poor nutrition and its relation to subsequent health and development in foster children.MethodRelevant studies for inclusion were identified from numerous sources (e.g., PubMed, Google Scholar, and reference sections). Inclusion criteria were studies published between 1990 and 2016 of (i) the nutritional status of children in foster care or (ii) the nutritional status of children exposed to early adversity (e.g., low-income and internationally adopted children) or (iii) the developmental effects of poor nutrition and micronutrient deficiencies.ResultsTwo key findings that have adverse implications for cognitive development emerged: (i) the prevalence of anemia and iron-deficiency anemia is higher among foster children than among the general population of children in the U.S., and (ii) the developmental demands of catch-up growth post-placement may lead to micronutrient deficiencies even after children have begun sufficient dietary intake of these nutrients. Moreover, there is a paucity of recent studies on the nutritional status of children in foster care, despite the multiple factors that may place them at risk for malnutrition.ConclusionAttention to nutritional status among care providers and medical professionals may remove one of the possible negative influences on foster children's development and in turn significantly alter their trajectories and place them on a more positive path early in life. Recommendations for further research, policy, and practice are discussed.     

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.     

Psychotropic medications in child welfare: From federal mandate to direct care

Background and objectiveChildren in the welfare system are prone to uncoordinated and unmonitored mental health care, including psychotropic medications. To address these issues, federal legislation mandated that state child welfare agencies improve the coordination and oversight of psychotropic medications. However, there is no clear guidance on how to improve these practices, particularly at the level of direct care. We aimed to identify specific areas for improvement through state-wide surveys of four groups.MethodsWe surveyed all known members of four groups working directly with children in foster care in one small northeastern state. Respondents included 209 foster and adoptive parents, 169 child welfare staff, 84 mental health therapists, and 33 clinical prescribers. Survey items addressed practices and perceptions related to sharing of information and cross-system communication and monitoring of medication effects and side effects.ResultsNearly two in five foster and adoptive parents reported not regularly receiving information about the purpose or side effects of psychotropic medications, and they disagreed among themselves on who was primarily responsible for monitoring safety and effectiveness. One-third of child welfare staff and two-thirds of mental health therapists reported that information about psychotropic medications is not regularly shared with the child's provider team. Half of clinical prescribers reported not regularly communicating with child welfare staff.ConclusionsWe identified specific areas for improvement related to communication, sharing of information, monitoring, and role clarification. Strategies to improving these activities are key to ensuring the safe and effective use of psychotropic medications in this population.     

Agency-Related Barriers Experienced by Families Seeking to Adopt From Foster Care

ABSTRACT

Although about 100,000 children in foster care await adoption, families approved to adopt encounter obstacles in the adoption process. This nationwide longitudinal study identified agency-related barriers faced by prospective adoptive parents. A pur-posively recruited sample of 300 families seeking to adopt from foster care completed an in-depth, semi-structured telephone interview and quarterly follow-up surveys until they either finalized a foster care adoption (n = 98) or discontinued (n = 102) the process, followed by an exit interview by telephone. Findings revealed the top barriers encountered were adoption process logistics (n = 185, 92.5%), agency communication and responsiveness (n = 159, 79.5%), agency emotional support (n = 130, 65%), availability of services (n = 65, 32.5%), and juris-dictional and interjurisdictional issues (n = 52, 26%). Policy and practice implications are provided with recommendations for improving procedures, services, support, and communication to better retain prospective adoptive parents and improve adop-tion outcomes.     

Implementation frameworks in child,youth and family services – Results from a scoping review

Background & objectivesImplementation frameworks are designed to articulate the actions and behaviors considered necessary for successful implementation of interventions, programs or services. Such frameworks have been increasingly used in social services for children, youth and families (which include family and parenting support, out-of-home care (foster care) placements, child protection, family violence, juvenile justice and community services). The purposes of this review were (a) to identify studies employing an implementation framework in this field; (b) map the literature to better understand these frameworks and the ways in which they are being applied; (c) to ascertain the ways in which implementation frameworks are being tested; and (d) to describe the current state of evidence surrounding their use in the field.MethodFor this scoping review, searches of the literature were conducted within PsycINFO, MEDLINE, CINAHL, ASSIA, Embase, Embase Classic, Social Work Abstracts, ERIC and Sociological Abstracts. Databases were searched for published, peer reviewed English language evaluation studies that applied - and reported on this application - implementation frameworks in the child, youth and family service sector. No limits were placed on years. Any type of study design was eligible from single case studies to randomized controlled trials.ResultsOut of a total of 8541 publications located, thirty-three met the inclusion criteria. They included eight frameworks that have been applied in the sector. Few of the identified frameworks were based on rigorous research designs. Common strategies used within the frameworks included staging implementation, key influences (e.g., competencies, organizational factors, leadership), stakeholder identification and engagement, and capacity measurement and building. Rarely were these approaches theoretically grounded or fully developed, and limited information was provided about their characteristics, development or interconnectedness. In short, research underpinning frameworks and their use has been meager, especially considering their proliferation in the field.ConclusionsThis review identifies a need to strengthen the conceptualization of core strategies that are integrated into implementation frameworks, including an articulation of their underlying logic. In the future, implementation science and practice may gain from moving away from comprehensive and complex implementation frameworks towards a more flexible, modular approach to implementation based on the application and combination of effective ‘implementation core strategies’. Future research may also draw a more complete picture of the state of implementation frameworks by expanding search terms to also include other sectors and domains into systematic reviews.     

Foster parents exposed to political violence: The role of social support in addressing emotional and functional difficulties

BackgroundBeing a foster parent is stressful. It becomes even more stressful when foster parents face major threats to their own families and to the foster children in their care, such as during war situations. This study focuses on foster parents' reactions to the war with Gaza in southern Israel that took place in 2014. The first goal of this study was to describe posttraumatic symptoms (PTS) and problems in functioning among foster parents following their exposure to the war. The second goal was to identify background and social support predictors of PTS and functioning problems among these parents. The third goal was to examine the role of formal and informal support received by the parents as a moderator of the association between exposure to war events and PTS and problems in functioning.MethodsParticipants were 354 Israeli foster parents who were exposed to the war. Participants completed structured instruments of exposure to war events, PTS, functioning, and social support.ResultsExposure to war events was associated with PTS and related functioning problems. Education and religiosity were correlated with PTS and problems in functioning. Contrary to our hypothesis, more formal social support was associated with more PTS. Social support did not moderate the association between exposure to war events and PTS.DiscussionThe unexpected positive correlation between support and PTS was interpreted as either reflecting the fact that foster care agencies targeted foster parents who were most in need, or as a reflection of the inadequacy of the support they received. The findings indicate that foster parents need support during times of major stressful events such as natural disasters and wars, so that they will be able to help the children in their care. Specialized professional training for foster care workers needs to be implemented. Future longitudinal and mix-methods studies are suggested to help address the limitations of the present study.     

Challenging implicit bias: preparing students to practice with African American families

ABSTRACT

The disparity of African American families in the foster care system is a concern in the field of child welfare services and the social work profession. African American families experience unique challenges related to discriminatory practices and implicit biases in the child welfare system and by mandated reporters. To address these inequalities, state and local agencies have implemented prevention and intervention services to support minority families. Additionally, child welfare agencies have invested in professional development training for their workers to alleviate possible intolerant practices. This article describes implicit biases and considers how they could contribute to the disparity of African American families involved in the child welfare system. Furthermore, the article presents approaches to help social work students to identify and challenge their implicit biases to support culturally sensitive practices while working with African American families. It concludes with implications for social work education.     

Explaining variations in state foster care maintenance rates and the implications for implementing new evidence-based programs

BackgroundU.S. Child Welfare systems are involved in the lives of millions of children, and total spending exceeds $26 billion annually. Out-of-home foster care is a critical and expensive Child Welfare service, a major component of which is the maintenance rate paid to support housing and caring for a foster child. Maintenance rates vary widely across states and over time, but reasons for this variation are not well understood. As evidence-based programs are disseminated to state Child Welfare systems, it is important to understand what may be the important drivers in the uptake of these practices including state spending on core system areas.Data and methodsWe assembled a unique, longitudinal, state-level panel dataset (1990–2008) for all 50 states with annual data on foster care maintenance rates and measures of child population in need, poverty, employment, urbanicity, proportion minority, political party control of the state legislature and governorship, federal funding, and lawsuits involving state foster care systems. All monetary values were expressed in per-capita terms and inflation adjusted to 2008 dollars. We used longitudinal panel regressions with robust standard errors and state and year fixed effects to estimate the relationship between state foster care maintenance rates and the other factors in our dataset, lagging all factors by one year to mitigate the possibility that maintenance rates influenced their predictors. Exploratory analyses related maintenance rates to Child Welfare outcomes.FindingsState foster care maintenance rates have increased in nominal terms, but in many states, have not kept pace with inflation, leading to lower real rates in 2008 compared to those in 1991 for 54% of states for 2 year-olds, 58% for 9 year-olds, and 65% for 16 year-olds. In multivariate analyses including socioeconomic, demographic, and political factors, monthly foster care maintenance rates declined $15 for each 1% increase in state unemployment and declined $40 if a state's governorship and legislature became Republican, though significance was marginal. In analyses also examining state revenue, federal funding, and legal challenges, maintenance rates increased as the federal share of maximum TANF payments increased. However, > 50% of variation in foster care maintenance rates was explained by unobserved state-level factors as measured by state fixed effects. These factors did not appear to be strongly related to 2008 Child Welfare outcomes like foster care placement stability and maltreatment which were also not correlated with foster care maintenance rates.ConclusionsDespite being part of a social safety net, foster care maintenance rates have declined in real terms since 1991 in many states, and there is no strong evidence that they increase in response to harsher economic climates or to federal programs or legal reviews. State variation in maintenance rates was not related to Child Welfare outcomes, though further analysis of this important relationship is needed. Variability in state foster care maintenance rates appears highly idiosyncratic, an important contextual factor to consider when designing and disseminating evidence-based services.     

Decision-making around psychotropic medications for children in foster care: Perspectives from foster parents

Background and objectiveChildren in foster care have complex mental health needs and receive high rates of psychotropic medications. Rarely can foster parents make legal decisions about treatment, yet they are intricately involved in the child's life and responsible for the child's safety and well-being. We aimed to conduct the first study of foster parent perspectives on decision-making relevant to the use of psychotropics with children in foster care.MethodsWe conducted semi-structured phone interviews with 13 parents in a small northeastern state who had fostered a child receiving psychotropics in the past 5 years. The state child welfare agency sent information about the study via email to all foster and adoptive parents for whom they had email contact. Interviews queried parents' knowledge and attitudes toward psychotropics, engagement in decisions, and recommendations for the decision-making process. Interview responses were coded and synthesized using mixed inductive and deductive methods in Dedoose software.ResultsChildren came into care on an average of four psychotropics. Parents reported receiving little information about the medications and finding information on their own. Parents acknowledged the potential benefits of medications, yet attitudes were largely against their use. Internal and external pressures for and against the use of medications were described. Many parents felt left out of the decisions and recommended team decisions.ConclusionsEfforts to improve foster parents' knowledge of medications, side effects, and monitoring, as well as team decision protocols, are sorely needed to improve decisions for this population.     

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.