Self-esteem: A mediator between peer relationships and behaviors of adolescents in foster care

Youth in foster care have been shown to be at risk for a range of negative behaviors. Developmental research has highlighted the important role that peer relationships can play in an adolescent's development. For youth in foster care, peer relationships can also play an important role in both youths' internal perception of themselves and their enacted behaviors. This study utilized National Survey of Child and Adolescent Wellbeing, a national secondary dataset to analyze the connection between peer relationships for youths in long-term foster care and their report of internalizing, externalizing, and delinquent behaviors (n = 188). Additionally, the self-esteem of adolescents was explored as a potential mediator between peer relationships and these behaviors. Preliminary analyses indicated that peer relationships had a significant association with all three of the identified behaviors: internalizing, externalizing, and delinquent behaviors of youths in foster care. Self-esteem was found to be a significant mediator between peer relationships and adolescents' report of their internalizing, externalizing, and delinquent behaviors. Clinical implications for therapeutic services that focuses on the adolescent's self-image and potential policy implications are discussed.     

The Family and Social Networks of Recently Discharged Foster Youth

Many youth leave foster care with disrupted relationships with family and others in their social networks. Previous research has documented the severe adversity that former foster youth face in the transition to young adulthood. Some of these difficulties are at least partially related to a lack of social support that results from frayed relationships. The purpose of this research was to examine the role that social support plays in the transition to adulthood. It was hypothesized that foster youth with higher levels of social support would make more successful adaptations to early adulthood than youth without that support. Ninety-seven former foster youth were followed for 2 years. Youth reported low levels of “feeling close to parents,” but higher levels of “closeness” were expressed for other relatives. Findings were mixed. Organizational involvement and having many “close” friends were associated with better outcomes. On the other hand, family contact and family support was inversely associated with resiliency. The implications of these findings are discussed.     

School performance in primary school and psychosocial problems in young adulthood among care leavers from long term foster care

We used data from Swedish national registers for ten entire birth year cohorts (1972-1981) to examine psychosocial outcomes in young adulthood for youth that left long term foster care after age 17, comparing them with majority population peers, national adoptees and peers who had received in-home interventions before age 13. The population was followed in the registers from age 16 to 2005. Data were analyzed in Cox regression models.Youth who left long term foster care had six-to eleven fold sex and birth year adjusted excess risks for suicide attempts, substance abuse and serious criminality from age 20, and for public welfare dependency at age 25. Overrisks were considerably lower for the in-home intervention group and the national adoptees. Adjusting results for poor school performance in the final year in primary school (ages 15-16) reduced overrisks by 38-52% for care leavers from long term foster care.Irrespective of issues of causality, poor school performance seems to be a major risk factor for future psychosocial problems among youth who age out of long term foster care. The results suggest that promoting foster children's school performance should be given high priority by agencies.     

The effects of adoption openness and type on the mental health,delinquency, and family relationships of adopted youth

ABSTRACT

Analyzing the 2007 National Survey of Adoptive Parents, this study examines the impact of open adoption, demographics, and other factors on adopted children’s mental health, delinquent behavior, and family relationships. Specifically, we compare findings for youth in private and public (i.e., foster care) adoptions and identify key similarities and differences between predictors of children’s well-being across these two types of adoption. We find that youth in open foster care adoptions are more likely to receive an attachment disorder diagnosis than those in closed foster care adoptions but are also more likely to have family relationships characterized by trust and adoptive parents’ willingness to recommend adoption to others. Further, we find children in both public and private adoptions who are older at placement are more likely to have posttraumatic stress disorder diagnoses. For children in private adoptions, no statistically significant predictors affected youths’ delinquency outcomes or family relationships, with the exception of parents of private adoptees in households characterized by lower levels of poverty indicating they would be more likely to recommend adoption to others. The implications of the key findings are discussed with regard to service provision for multiple types of adoptive families.     

Perceived self-stigma in the utilization of mental health services in foster care and post foster care among foster care alumni

Foster youth experience higher rates of mental health disorders and receive higher rates of mental health services in comparison to the general population. Yet, upon foster care exit, mental health service use drastically declines. Little is known as to the reasons for mental health service decline after foster care exit. However, research studies in the mental health literature have consistently shown that self-stigma and public stigma are significant in mental health service receipt. Studies have also shown that self-stigma affects an adolescent's self-identity, self-efficacy, and interpersonal relationships, which impact self-sufficiency once youth leave foster care. This study explores self-stigma in the utilization of mental health services while in foster care, and whether the stigma developed while in foster care impacts mental health service use upon foster care exit. The role of public stigma in the utilization of mental health services post foster care is also examined. Thirteen former foster youth with a mental health treatment history while in foster care were interviewed. Results show that foster youth experienced self-stigma, which increased the negative impact of mental health service receipt while in foster care. After foster care exit, youth who identified experiencing self-stigma while in foster care tended to discontinue mental health services after foster care exit. In contrast, foster youth who did not identify self-stigma in the receipt of mental health services while in foster care continued accessing services upon foster care exit. Public stigma was not identified as influencing mental health service use post foster care, but was coupled with negative labels, stereotypes, and negative perceptions. Implications for preventive and intervention measures are also discussed/proposed.     

Evaluation of a multi-site program designed to strengthen relational bonds for siblings separated by foster care

Sibling relationships in foster care settings have received increased attention in recent years. Despite growing evidence regarding the protective potential of sibling relationships for youth in care, some sibling groups continue to experience foster care related separation, and few programs exist to address the needs of these youth.This study describes and evaluates Camp To Belong, a multi-site program designed to provide short-term reunification to separated sibling groups through a week-long summer camp experience. Using a pre-test post-test survey design, this paper examines changes in youth ratings of sibling conflict and sibling support across camps located in six geographically distinct regions of the United States. The effects of youth age, number of prior camp exposures, and camp location were tested using multilevel modeling procedures.Findings suggest that participation in Camp To Belong may reduce sibling conflict, and improvements in sibling support are noted for youth who have had prior exposure to the camp’s programming. Camp-level variance in the sibling support outcome highlight the complex nature of relationships for siblings separated by foster care, and suggest the need for additional research. Lessons learned from this multi-site evaluation and future directions are discussed.     

Substance use in youth adopted from foster care: Developmental mechanisms of risk

Children who enter foster care are at unique risk for developing substance abuse due to experiencing early life stressors. A large body of research has revealed robust effects of various stressors on later substance use, implicating the role of early neurobiological changes that create chronic internalizing problems. However, less literature has investigated externalizing behavior as a mechanism underlying this relationship. Moreover, few studies have examined these mechanisms through a model of cumulative risk. The present study examined whether the prospective association between cumulative pre-adoptive risk (e.g., maltreatment, age at placement, foster placement instability, ever having lived with birth parent) and adolescent/young-adult substance use was mediated by childhood internalizing and externalizing problems in youth adopted from foster care. Participants included 82 adoptees, most with histories of prenatal substance exposure (72%). We tested parent-rated internalizing and externalizing problems across 5 years in childhood as simultaneous mediators of cumulative risk and level of substance use 11–15 years later. Bootstrapping mediation procedures, controlling for age, prenatal substance exposure, adolescent/young adult mental health symptomatology, and youth participation in follow-up, revealed a significant indirect effect of cumulative risk on substance use through childhood internalizing problems, but not externalizing problems. These results underline the importance of mitigating early risk for children in the child welfare system and call for targeting childhood emotion dysregulation to reduce likelihood of substance abuse among previously high-risk adoptees. Nevertheless, low rates of substance use overall in the present sample underscore the positive impact of adoptive placement on mitigating risk for substance abuse among foster youth.     

The Promise of an Accumulation of Care: Disadvantaged African-American Youths’ Perspectives About What Makes an After School Program Meaningful

African-American youth growing up in dangerous, deprived homes and communities are at great risk of developing impaired relationship capabilities, which disadvantages them further in the workplace and in their personal lives. While after-school programs have well-documented positive effects, researchers have called for better understanding of improving youths’ engagement in services and their constructive relationship skills. Here, we report on a project using participatory action methods to engage poverty-level African-American youth in developing a leadership development program they would find most meaningful. Stand Up Help Out (SUHO) gave youth three layers of caregiving experience: receiving care from instructors, giving and receiving care from peers, and providing care through constructive community action initiatives and mentoring elementary school children. Findings were that: (1) participation and retention of youth in SUHO were considerably higher than national averages; (2) youth reported that SUHO made it possible for them to have better relationships as friends, romantic partners, and in academic settings, and they looked forward to being better parents, (3) youth developed positive peer relationships despite a context of mistrust and gang violence, (4) youth actively sought out relationships with caring adults and identified what was most meaningful in those relationships, and (5) youth deeply valued the opportunity to develop their ability to care for others.     

Instability in the lives of foster and nonfoster youth: Mental health impediments and attachment insecurities

Foster youth are at risk for negative mental health and psychosocial outcomes, including when they are on the brink of emancipation from care into self-sustained adulthood. Factors believed to affect outcomes among foster youth include residential and school instability. Although frequent moves to new homes and schools are common for youth living in poverty, instability for foster youth involves not only changing homes and schools but often also changes in caregivers, thus putting foster youth at risk for disrupted attachment relationships. For the current study, structural equation models examined links between instability, mental health problems, and attachment insecurities in foster and at-risk nonfoster youth. A model containing instability provided a better fit to the data than a model containing foster care status only. Group comparisons revealed that instability was associated with posttraumatic stress disorder symptoms for foster but not nonfoster youth. Implications of instability in the lives of foster youth are discussed.     

Sibling relationships and internalizing symptoms of youth in foster care

Compared to the sibling literature of the general population, little is known about sibling relationships of youth in foster care. The current study aimed to report on sibling relationships among youth in foster care, and investigate the potential protective nature of sibling relationships of those who have experienced trauma on the expression of internalizing symptoms among a nationally representative sample of 152 adolescents in foster care. Results indicated that the large majority of the sample was currently separated from their sibling. Of those who were not living with their sibling, nearly three quarters saw their sibling monthly or less frequently with one third of the sample reporting never having any contact with their sibling. In addition, bootstrapping methods were used to determine if sibling relationships mediated the effect of trauma on internalizing symptoms. Results indicated that a positive sibling relationship significantly mediated this relationship. Implications of these findings are discussed.     

“I don't know where I would be right now if it wasn't for them”: Emancipated foster care youth and their important non-parental adults

Research has identified the benefits of having non-parental adults for older youth in foster care, but less is known about the characteristics of these relationships, as well as the processes that support the foster youth as they transition from care to independence. The present study included a diverse group of 99 young adults, who recently emancipated from care in a major U.S. city. These young adults reported having a very important non-parental adult (VIP) and 63 of these VIPs were also included in this study. The youth participated in a two-hour in-person interview followed by a survey, and the VIPs underwent a phone interview; all of these interviews were later transcribed and qualitatively coded using thematic analysis. Overall, this study aimed to: 1) identify the characteristics of these VIPs, and 2) elucidate how the VIPs support youth during the transition from care. Prominent characteristics of the youth and VIP relationship identified in this study include the relationship being “parent-like”, respectful, and reciprocal with regards to communication. Moreover, it was found that both the youth and the VIPs viewed these relationships to be important in reducing negative outcomes for the youth. These results call for the foster care system to take steps in helping foster care youth find and build relationships with the non-parental adults in their lives — VIPs can serve as important sources of support to aid foster youth in their adaptation to young adulthood.     

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.     

Pre-foster Care Maltreatment Class as a Predictor of Maltreatment in Foster Care

The majority of youth in the foster care system have been removed from their homes as means of protection against parental maltreatment. Studies have shown, however, that foster youth may continue to experience maltreatment after they have entered the child welfare system (Poertner et al. in Child Youth Serv Rev 21(7):549–563, 1999; Tittle et al. in Urbana 51:61801, 2008). In this study, we explore how maltreatment prior to foster care entry may predict maltreatment while in care for youth who are preparing to emancipate. Using latent class analysis and multinomial logistic regression, we find that current or former foster youth with histories of multiple maltreatment (particularly, combined pre-foster care histories of neglect and physical abuse) are more likely to report neglect, physical abuse and sexual abuse in care than those with histories of low maltreatment. These youth should be the target of prevention efforts in child welfare agencies.     

Sibling relationships of youth in foster care: A predictor of resilience

Few empirical investigations have been conducted examining sibling relationships among youth in foster care, and even fewer have explored relationship warmth as a protective factor. With a sample of 246 youth from a non-profit organization's summer camp program, Camp To Belong, this study examined the association between a warm sibling relationship and resilience for youth in foster care. A warm sibling relationship significantly predicted individual resilience for both middle childhood and adolescence developmental periods. Younger youth with poorer sibling relationship warmth had lower resilience. The implications of these findings are important given that resilience is a factor associated with improved outcomes in the face of adversity. The promotion of sibling relationships, a readily available resource, can be drawn upon by those in clinical practice to improve outcomes for youth in foster care.     

The Role of Social Support in the Transition From Foster Care to Emerging Adulthood

Many youth leave foster care with disrupted relationships with their family and others in their social networks. Previous research has documented the severe adversity that former foster youth face in the transition to young adulthood. Perhaps some difficulties are at least partially related to a lack of social support that results from frayed relationships. This article reviews the literature on social support, particularly as it relates to foster youth, for the purpose of examining the role that formal and informal supports play in the transition to adulthood. The implications of this literature for successful transitions for former foster youth are discussed, as well as ways child welfare workers can engage youth and their families, and help them develop supportive social networks.     

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.     

It's good to know that you got somebody that's not going anywhere: Attitudes and beliefs of older youth in foster care about child welfare-based natural mentoring

This exploratory study is the first to investigate the attitudes and beliefs of older adolescents in foster care toward the implementation of a child welfare-based natural mentoring intervention designed to promote enduring, growth-fostering relationships between youth at risk of emancipation and caring, supportive nonparental adults from within the youth's existing social network. Six focus groups were conducted with 17 older youth in foster care attending a specialized charter high school for young people in out-of-home care in a large, urban city in the Northeast United States. Focus group data were transcribed and analyzed using a conventional content analysis approach. The following significant themes emerged related to natural mentoring for older foster youth emancipating from care: (1) need for permanent relationships with caring adults, (2) youth conceptions of natural mentoring, (3) unique challenges related to natural mentoring for youth in foster care, (4) role of a natural mentoring intervention in child welfare, and (5) challenges for implementing a child welfare-based natural mentoring intervention. Overall, our findings suggest that these young people are cautiously optimistic about the potential of a child welfare-based natural mentoring intervention to promote their social and emotional wellbeing. Future studies are needed to better understand the experiences of older foster youth with an actual natural mentoring intervention, including challenges, opportunities, and outcomes.     

Qualitative evaluation of historical and relational factors influencing pregnancy and sexually transmitted infection risks in foster youth

PurposeTo explore how attitudes, norms, behaviors, responses to early life experiences, and protective factors influence pregnancy and sexually transmitted infection risks from the perspectives of current and former foster youth to inform the development of prevention strategies.MethodsWe conducted semi-structured individual qualitative interviews with a diverse sample of 22 current/former foster youth aged 15–21 years (63% female; average age = 18.6 years). We then used Theoretical Thematic Analysis to systematically analyze the data for key themes related to sexual health in four categories: 1) norms and attitudes, 2) responses to early life experiences, 3) protective factors, and 4) youth-driven intervention ideas.ResultsParticipants reported a range of sexual experience levels, varied sexual orientations, and also reported varied life experiences prior to and during foster care. We detected several norms and attitudes that likely contribute to risks of early pregnancies and sexually transmitted infections. These included that one can tell by looking whether a partner is trustworthy or has a sexually transmitted infection, that condoms aren't necessary with long-term or infrequent partners or if birth control is used, and that teen pregnancy is an inevitable event. With respect to responses to early life experiences, youth frequently described difficulties dealing with strong emotions in the context of romantic and/or sexual relationships; many attributed these difficulties to early experiences with biological family members or in foster care. Participants linked emotion regulation difficulties with struggles in trust appraisal, effective communication, and impulsive behaviors. Youth also described a variety of protective factors that they felt helped them prevent sexual risk behaviors or improved their lives in other respects. Finally, participants endorsed factors likely to improve intervention acceptability and efficacy, including an open, non-judgmental group-based environment, involvement of peer mentors, and inclusion of caregiver and caseworker training components.ConclusionsTrauma-informed, tailored intervention strategies which address key norms and attitudes and provide broad-based assertiveness and emotion regulation skills are likely to be the most effective strategies to reduce risks of teen pregnancies and sexually transmitted infections among teens in foster care. Group-based interventions that involve peer mentors and caregiver and caseworker components may be especially acceptable and effective for teens in foster and/or kinship care.     

“No One Acknowledged My Loss and Hurt”: Non-death Loss,Grief, and Trauma in Foster Care

How do youth in foster care experience non-death loss? Drawing upon the theories of ambiguous loss, symbolic loss, and disenfranchised grief, this applied theoretical article integrates research findings to address how youth experience loss, grief, and trauma in foster care. Youth’s reports illustrate experiences of non-death loss, the impact of non-death loss on psychological and emotional well-being, and how non-death losses are disenfranchised and enfranchised within the foster care system. Recommendations are made that child welfare agencies consider how their practices and policies can be enhanced to meet the needs of grieving youth in foster care.