Specialized foster care and group home care: Similarities and differences in the characteristics of children in care

Until recently, foster children who presented special medical or behavioral problems were largely served in group care environments. Specialized (or “treatment”) foster care has recently been developed to serve some of these challenging children. Although growing evidence points to the special needs of children in foster care, much is still unknown about how children placed in various out-of-home care settings differ from one another. The growth of specialized foster care as an alternative placement to group care, calls for examination of how children in these settings compare on demographic, educational, health, and behavioral characteristics. A cross-sectional mailed survey was distributed to all group care and specialized foster care agencies in a large state to address topics related to children's characteristics. Comparisons point to two groups of very difficult children, with unique mental health and health needs.     

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.     

A Study of Adopted Children,Their Environment,and Development: A Systematic Review

The study explores the developmental consequences for children who have been adopted. The comparison group is comprised of their non-adopted siblings or children in foster homes or group care. A search in scientific databases resulted in more than 3,300 hits about adoption. Among these, 56 fulfilled the selection criteria from 17 studies across more than 2,000 adoptees and controls. Adopted children scored higher on IQ, school-performance, and lack of behavioral problems than their non-adopted siblings or peers who stayed behind in orphanages or foster homes. The results from OECD countries were similar to those from studies in Chile, Lebanon, and India.     

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.     

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.     

The health status of foster children

A study of the health care and needs of foster children in the New York City area indicated a prevalence of serious physical, mental and developmental problems. The level of pathology was roughly comparable to that of other disadvantaged child populations.     

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.     

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.     

Foster child health care supervision policy

Foster children represent a high-risk group for physical, emotional, and social health problems, yet few federal or state policies explicitly address foster child health. This article reviews foster child health and the legal background for policy, then discusses components of a comprehensive health care supervision program.     

Parent-child interaction therapy: application of an empirically supported treatment to maltreated children in foster care

One of the more serious problems faced by child welfare services involves the management of children with serious behavioral and mental health problems. Aggressive and defiant foster children are more likely to have multiple foster care placements, require extraordinary social services resources, and have poor short- and long-term mental health outcomes. Interventions that work with challenging foster children and enhance foster parents' skills in managing problem behaviors are necessary. This article presents the successful results of a single case study examining the application of Parent-Child Interaction Therapy (PCIT) with an aggressive young boy and his foster-adoptive parent. PCIT is a dyadic intervention that has been identified as an empirically supported treatment for abused children and for children with different types of behavioral disruption. The application of PCIT to assist foster parents is a promising direction for child welfare services.     

Health outcomes for adults in family foster care as children: An analysis by ethnicity

Studies have linked the experience of child abuse or adversity to health problems in adulthood, and researchers have long documented health problems affecting children in foster care. Yet, the adult health outcomes of maltreated children placed in foster care have not been sufficiently isolated. Although information on transitioning youth and young adults is now beginning to emerge, the impact of ethnicity on adult health outcomes has been largely ignored. Given the overrepresentation of ethnic minority children in foster care and the national disparities in the health of ethnic minorities, this study examined the relationship between ethnicity and physical health outcomes for African American, Hispanic, and White adults who experienced family foster care as children. Logistic regression models indicated that ethnicity was not a significant predictor of physical health (p > .05). However, gender and age were associated significantly with their physical health outcomes.     

A psychoanalytic psychiatrist in the world of foster care

Recent developments in psychoanalytic developmental psychology offer a conceptual framework for understanding the effects of inadequate parenting on psychological development. The very need for foster care, almost by definition, usually indicates that parenting has been inadequate, and there fore children in foster care comprise a special population of developmentally handicapped individuals. Many of the problems that confront foster care agencies can be understood in terms of the individual child's psychological developmental arrest and its deleterious effect upon his or her ability to benefit from placement. Certain cultural factors within the community involved with foster care compound the problem. More clinically sophisticated service is therefore a key element in the remediation of many of the obstacles to adequate foster care services.Earlier versions of this paper were presented at the Meeting of The American Psychoanalytic Association in Atlanta, Georgia, May 1978 and in New York City, December 1978.     

Compliance and Internalization in Preschool Foster Children

Child compliance and internalization are socio-cognitive developmental processes which are critical for children's social outcomes in multiple arenas. These developmental processes are found to be compromised in maltreated children. The current study was designed to add to the extremely limited literature on compliance and internalization in maltreated children in foster care. Compliance and internalization tasks were administered to preschool foster children, videotaped and later coded. Through parent-report questionnaires completed by the foster parents and observations of the foster home, the relation of compliance/internalization to child behavior problems, foster care experiences, and the foster home environment was examined. Findings revealed that most children showed committed compliance, but over 50% of children exhibited “deviation” behaviors in the internalization task. HOME acceptance scores (via observation of parent and child in home setting) significantly contributed to children's compliance levels but did not significantly contribute to their internalization. Internalization was related to children's externalizing behavior problems. These findings are considered in the context of future research and practice with respect to young children in foster care.     

Correlates of the Randolph Attachment Disorder Questionnaire (RADQ) in a Sample of Children in Foster Placement

This study examined mental health and attachment problems in children in foster care. This study also obtained data concerning the validity of the Randolph Attachment Disorder Questionnaire (RADQ). Children were selected according to length of time in placement and age and screened for mental health symptoms using the Child Behavior Checklist and the RADQ. The findings showed that children in foster care have reported symptoms within the range typical of children not involved in foster care. The conclusion is that the RADQ has limited usefulness due to its lack of specificity with implications for treatment of children in foster care.     

A study of 185 foster children 5 years after placement

This study's findings are similar to those of other studies. The majority of children who enter foster care return to their families within a relatively short time. A small group, because of the severity of their problems or those of their parents, need extended care. This group of children, over time, form the hard core of foster care placements. Our findings also bear out those of others that the foster care experience is a relatively stable one for children, with the majority having one or two placements while in care. Clearly, the need for and use of foster care is frequently misunderstood. The methodology used in research studies has gradually improved, adding to objective knowledge about this aspect of the child welfare system. Longitudinal studies, such as Jenkins [1967], Fanshel and Shinn [1978], and the one reported here, point to the need for deeper, more refined studies that examine not only the going and coming of children in foster care but the professional service component that can make foster care a constructive experience for children placed in it. Meyer issued an intelligent and timely challenge to the field of child welfare to give up "debates about permanency" and, if it is not too late, to "retrieve child welfare from the control of lawyers and MBAs" [1984: 499]. If the profession of social work can more clearly define the components of foster care service and can differentiate among the children needing care those who can best be served by this type of placement, then the field will be well on its way to offering an appropriate service for certain children. Attempts to denigrate a potentially helpful service for needy children simply destroy one aspect of a complex system. A wide range of services is necessary to serve all children appropriately. Without this kind of continuum, children are more likely to receive inappropriate services and to be placed at risk.     

Directions for developmental screening in child welfare based on the ages and stages questionnaires

Many young children investigated for maltreatment have developmental problems qualifying them for early intervention services, yet only a portion of these children receive such services. To address this gap, all children ages 0-3 with child welfare (CW) substantiated maltreatment in Pennsylvania are screened for developmental and socioemotional problems using the Ages and Stages Questionnaires (ASQ). This study views screening results for over 500 children to address whether children's substantiation status, living situation, and administering worker as CW or early intervention (EI) predicts screening rates. Bivariate and logistic regression analyses were used. Results showed that 22% of children scored in the problem-range of at least one developmental area and 18% scored in the problem-range of social-emotional concerns warranting EI referral. Results of bivariate analyses showed that children who spent time in the NICU were more likely to have developmental concerns. Socioemotional concerns were related to child race, foster care living situation, child as the subject of the referral, and physical neglect. Older children and children whose referral involved lacking basic needs showed both developmental and socioemotional concerns. There were no significant differences in screening results of children with substantiated versus unsubstantiated maltreatment. Children whose screening was conducted by EI were more than three times as likely to show developmental concerns compared with those screened by CW. Child welfare workers need more support when conducting developmental screening, and policies that limit screening to children with substantiated maltreatment or to children in out-of-home care should be reconsidered.     

When Home Is Still Unsafe: From Family Reunification to Foster Care Reentry

Reuniting children with their families is the preferred outcome of foster care, yet many children reunited with their families reenter foster care. This study examined how parental substance abuse and mental health problems, and the time allotted for reunification, are associated with reentry risk. We used a complete cohort of children who entered the Texas foster care system in fiscal years 2008 and 2009 to identify the risk of foster care reentry within 5 years of reunification using selection‐adjusted multilevel survival analysis. Approximately 16% of reunified children reentered care within 5 years. Substance abuse and mental health problems predicted higher rates of reentry. Reunification after 12 months was associated with increased reentry risk overall, but not among children commonly exempted from federal permanency timelines. Permanency guidelines that restrict the length of time to achieve reunification may have the unintended consequence of pushing reunification before maltreatment risks have been resolved.     

Parental substance abuse and the development of children in family foster care

To determine the impact of parental substance abuse on children, the cognitive skills and behavior ratings of 268 school-age children placed in family foster care were examined. As a group, the children in family foster care presented with low average cognitive skills and made significant improvement in cognitive functioning during placement. The children with prenatal exposure to drugs scored significantly lower in cognitive skills at the beginning of placement but made significantly more progress than the other children during placement. Behavior ratings by the foster parents and teachers revealed that 29% of the children had scores in the significant range, and the children exposed prenatally to drugs had a higher incidence of behavior problems at school compared to family foster care peers. Recommendations for further study of these factors and for enhancing outcomes for children in care are provided.     

Measuring the willingness to foster children with emotional and behavioral problems

Many children in foster care have emotional or behavioral problems or are at risk for these problems. It is important to identify parents willing to foster children with these problems in order to ensure placement, care, stability and well-being of such children. This study presents a new 40-item self-report measure of the willingness of parents to foster children with emotional and behavioral problems, and two 20-item parallel forms of this measure. In addition, this study presents evidence of reliability and validity of scores derived from these measures with a national sample of 297 foster mothers. Coefficient alpha for these measures was .92 or greater, indicating excellent internal consistency reliability. Scores from these measures were unrelated to demographic characteristics, providing evidence of discriminant validity. In addition, scores from these measures were higher for foster mothers licensed to provide treatment foster care than for mothers only licensed to provide regular foster care, providing support for known groups validity. Finally, support for construct validity is provided by the fact that foster mothers with higher scores on these measures had fostered longer, were fostering more children at the time of this study, and had fewer children removed from their home at their request.     

Pediatricians and foster children

The poor state of health and health care of foster children is well documented. The cure lies in the hands of the agencies that administer the foster care system and pay for medical services, and in those of the physicians who provide that care. This study suggests that much of the problem may be solvable. Adequate numbers of pediatricians in Connecticut seem to be committed to caring for foster children, but major impediments remain, including inadequate reimbursement for both primary and specialty health services. The institution of a medical passport can make needed information available and help to establish and promote standards of care. Pediatricians appear willing to take a leadership role in assisting other agencies in developing programs to improve the care of these children; despite the problems in providing medical care to foster children, most pediatricians view it as part of their responsibility to the community and to all children.