Developing and Evaluating Theory-Based Messages to Promote Foster Care.

1. Sandra H. Jee, MD, MPH 1. Department of Pediatrics University of Rochester Rochester, NY 1. Mark D. Simms, MD, MPH 1. Department of Pediatrics Medical College of Wisconsin Milwaukee, Wisc Improving the Odds for the Healthy Development of Young Children in Foster Care . Dicker S, Gordon E, Knitzer J. National Center for Children in Poverty: Columbia University Mailman School of Public Health. Promoting the Emotional Well-Being of Children and Families (Policy Paper No. 2). January 2002;1–28 Children and Family Services Reviews, Part V: Most States Fail to Meet the Mental Health Needs for Foster Children . Huber J, Grimm B. Youth Law News . 2004;Oct-Dec:1–36 CWLA Standards for Health Care Services for Children in Out-of-Home Care . Washington, DC: Child Welfare League of America; 1988. Educational Experiences of Children in Out-of-Home Care . Smithgall C, Gladden RM, Howard E, Goerge R, Courtney M. Chicago, Ill: Chapin Hall Center for Children at the University of Chicago; 2004:1–77 Fostering Health: Health Care for Children and Adolescents in Foster Care . 2nd ed. Task Force on Health Care for Children in Foster Care, American Academy of Pediatrics, District II, New York State. Elk Grove Village, Ill: American Academy of Pediatrics: 2005 Healthy Foster Care America . www.aap.org/advocacy/HFCA/ On any given day, more than 500,000 children are living in state-supported foster home care. In the course of a year, more than 800,000 children experience placement in a foster home. Many of these children return home quickly, but for some, placement may extend for years and may involve care in multiple foster homes. Most of the children have experienced serious family dysfunction prior to placement, including exposure to domestic violence and to their parents’ mental health disorders, addiction, or criminal activity. Serious neglect and abuse are the most frequently stated reasons for removing children from their parents’ care. Children entering foster homes have extremely high rates of physical and mental health problems, developmental delays, and educational underachievement. As a group, children in foster care …

Kinship Care

This research paper explores the foster care framework in Greece, with a particular focus on the triadic relationship among foster carers, biological parents, and foster children. It refers to the current 30 hours compulsory training program of foster parents, emphasizing the necessity of a further specialized comprehensive training, on the ground that well prepared foster carers can better face the complexities of fostering. There is also an imperative need for ongoing support for foster parents, which will be provided in the context of social workers’ supervision to meet the behavioral and emotional challenges presented by foster children. The study investigates the potential hindrances faced during the child's placement within the foster home and the vital role social workers play in addressing these difficulties. It delves into the backgrounds of biological parents, foster carers, and foster children, examining the psychological issues and trauma they may confront. The paper highlights the paths of creating an emotional bond, trusting relationships, amongst the child and his/her foster parents and contact issues between foster and biological parents, asserting that these elements are crucial for the child's well-being and his/her integration into the foster family. Moreover, it recognizes the need for policy makers and practitioner’s collaboration and interdisciplinary approaches within the foster care system. The study concludes that well-structured support, the empowerment of children through resilience building, and a stable legal framework are foundational to successful application of the institution of fostering. It encourages future research in the form of longitudinal studies, the evaluation of training models, and cross-national comparisons that include Greek foster care organizations to ameliorate the effectiveness of foster care system. The research incorporates theoretical and research studies articles as well as selected books in the field to underline the importance of evidence-based practices in advancing the application of the institution of foster care as well as the experiences of both foster care children, biological and foster parents.

Reviewed by: Abusive Policies: How the American Child Welfare System Lost Its Way by Mical Raz Paul M. Renfro Abusive Policies: How the American Child Welfare System Lost Its Way. By Mical Raz. Chapel Hill: University of North Carolina Press, 2020. xvi + 162 pp. Paper $26.95, cloth $95. A mid the satanic ritual abuse panic of the 1980s, congresswoman Patricia Schroeder (D-Colorado) explained why such scares resonate with the American public. "You don't need to convince people that child abuse is bad," she proclaimed (114). Indeed, efforts intended to stamp out child abuse remain virtually unassailable. Yet, as historian Mical Raz illustrates in her terrific new book, understandings of child abuse—and thus the measures enacted to limit such abuse—have changed dramatically over the past half century or so. Abusive Policies explores the politics of child abuse from the late 1960s through the present, arguing that definitions of child abuse, neglect, and exploitation have expanded in the intervening years, while state and private mechanisms designed to curb abuse have grown more extensive, coercive, and punitive. Children and families of color, as well as poor and working-class families, have borne the brunt of these transformations, Raz shows, even as the racial, gender, and economic inequalities that enable and exacerbate child abuse remain largely unaddressed by the state and its private auxiliaries. Raz's story begins with the establishment in 1969 of Parents Anonymous, "a self-help group for parents who either abused or were concerned they might abuse their children." Originally called Mothers Anonymous—in keeping with the larger political and cultural "belief that mothers posed the greatest danger to their children"—Parents Anonymous "played a pivotal role in changing perceptions of child abuse" in the United States (9, 40). Specifically, Parents Anonymous helped shape the discourse surrounding the Child Abuse Prevention and Treatment Act (CAPTA). Signed into law in 1974, CAPTA "intentionally circumvented discussions of race and class" by "presenting child abuse as a scourge of all walks of society" (10, 11). As appealing as this framing might have been—particularly during the "post-civil rights" moment in which CAPTA passed—the act disregarded research that proved "that child abuse was more common in low-income families" and also foreclosed more robust, redistributive policy solutions (11). Raz reveals how such "social welfare" approaches—touted by researchers and advocates cognizant of the ways in which "poverty and social inequities" [End Page 317] precipitated child abuse—ultimately went "unheeded by politicians and policymakers" (32). These elite actors opted instead for ostensibly race- and class-neutral child abuse measures, a decision that reflected not only public skepticism of anti-poverty initiatives but also the increasing pathologization of poverty and crime, including the offense of child abuse. While supposedly race- and class-neutral, mandatory child abuse reporting requirements—which proliferated in the mid-to-late 1970s—"led to significant increases in reporting of low-income and minority families," even though "only a fraction of the[se] reports involved physical harm to children" (62). Many of these reports stemmed from alleged incidents of emotional or verbal harm, a consequence of the expanding definition of child abuse in the twentieth century's second half. This surge in reporting also prompted more muscular, more coercive, and more consistent state interventions in the lives of poor and working-class children and families, disproportionately those of color. These interventions often resulted in the criminalization of family members, the removal of children from familial and extended kinship networks, and the placement of children in foster homes. Further, such interventions offered little in the way of material support or other services for needy children and families. As Raz describes the situation in New York City in the late 1970s and early 1980s, "Foster care placement involved taking children from suboptimal homes that could have benefited from further support and placing them in homes where there was a greater danger of physical abuse and death" (84). Indeed, the placement of poor and working-class children in public foster care became increasingly common just as the foster care system desegregated and just as public assistance mechanisms grew more punitive and less generous, as scholars like Julilly Kohler-Hausmann...

Reviewed by: A Generation Removed: The Fostering and Adoption of Indigenous Children in the Postwar World by Margaret D. Jacobs Catherine E. Rymph A Generation Removed: The Fostering and Adoption of Indigenous Children in the Postwar World. By Margaret D. Jacobs. Lincoln: University of Nebraska Press, 2014. xxxv + 360 pp. Cloth $29.95. The story of indigenous child removal is a devastating one. The well-known Indian boarding schools of the late nineteenth century United States separated children from their families, communities, language, and culture and thus served as a radical assimilation project. Less familiar may be the ongoing removal of native children from their families deep into the twentieth century. In this fascinating book, Jacobs shows how post–World War II policy changes that scaled back governments’ existing obligations to indigenous peoples coincided with “purportedly color-blind liberalism” in the United States, Canada, and Australia to make indigenous placement in nonindigenous homes seem not only a practical but a humane way to promote the welfare of indigenous children (259). The book’s first two sections focus on Indian child removal in the United States and the grassroots activism that would come to oppose it. The third [End Page 347] section explores parallel histories in Canada and Australia. Although the particular legal and jurisdictional contexts were somewhat different in each country, there were remarkably similar patterns of reform and reaction in what Jacobs identifies as a global phenomenon. In the United States, beginning in the late 1950s, the Indian Adoption Project sought white parents to adopt Indian children and worked to persuade Indian mothers to relinquish newborns. The IAP was intended to address a host of perceived problems. For Jacobs, many of the “problems” that the experts were trying to solve through foster care and adoption were in fact “invented” by those same experts. By constructing children as “unwanted” and their families and communities as hopelessly impoverished and deviant, they helped create a powerful desire among liberal Americans to “rescue” these children as a way to address the “plight” of the Indian (39). Bureaucrats, Jacobs argues, too often turned to draconian solutions like child removal because they could not see the strengths that already existed in Indian families and because they were unable to imagine solutions for Indian children that involved shoring up Indian families and promoting economic and educational opportunity close to home. Native American activists, often initially motivated by the pain of their own experiences of child removal, argued that Indian children were not just members of nuclear families, but also of “extended families, clans, and tribes” (77). Thus the placement of a child outside the tribe affected the collective interests of a much larger group than just the child’s parents and could be seen as a form of cultural genocide. Jacobs details the remarkable stories of Native American activists (mostly women) and their white allies as they struggled to convey the harm done by the IAP. Their efforts culminated in the passage of the Indian Child Welfare Act in 1978, which aimed to curb the placement of Indian children outside of tribal communities by giving tribes sovereignty over child welfare. In the third section, Jacobs turns to the strikingly similar stories of Canada and Australia. The transnational approach allows us to see that Indigenous child welfare crises were “part of a pattern among settler colonial nations” (248). The grassroots movements against such policies were also international ones, strengthened by personal connections between activists in different countries that were stimulated by travel, speaking engagements, correspondence, and sharing of resources. Although indigenous child removal is indeed unique, there are also a number of fascinating parallels in the broader history of race, nationality, and poverty within adoption and foster care, which Jacobs might have done more [End Page 348] to acknowledge and address. That her book invites such comparisons, however, is a tribute to her thorough and complex treatment of a challenging subject. Scholars from a variety of fields will welcome this work. Catherine E. Rymph University of Missouri Copyright © 2016 Johns Hopkins University Press

Family Center is a comprehensive program which provides obstetrical and psychosocial services and methadone maintenance for pregnant drug-dependent women and their infants. Between 1979 and 1983, 171 women on enrollment to the program completed our Violence Questionnaire. Objectives of the questionnaire were: 1) to ascertain episodes and degrees of violence experienced by the women, including acts of physical and sexual abuse occurring in childhood or as an adult. 2) to learn if women reporting a history of violence/abuse were more likely to have had children in foster care. Individual item responses on the questionnaire, reported in percentages, were: Of the 171 women studied, 40% had children in voluntary or involuntary foster placement. Women with a reported history of sexual trauma, particularly if occuring in childhood or repeatedly, were significantly more likely to have children in foster care (p= <.01). Women who were physically abused (without sexual trauma) as children and/or adults were less likely to have their children in placement. This study suggests that failure to resolve childhood sexual trauma or coping with the trauma by use of illicit drugs, disrupts the ability of women to parent their own children. The effects of violence toward women, particularly when they themselves were children, may have untoward effects upon their own children.

This study examined the association between family homelessness and children's placement in foster care. The prevalence of homelessness in a random sample of 195 young foster children was examined. Almost half of the birth parents of the foster children had experienced homelessness. Those children were more likely than other foster children to have siblings in foster care and to be place with nonrelatives. An extremely high prevalence of family homelessness was found among children in foster care. Policy implications of the association between family homelessness and placement into foster care are discussed.

The literature on psychopathology among children in family foster care published in the last 20 years was reviewed to estimate prevalence and types of psychopathology in this population. A comprehensive computerized database was searched for the period 1974 through 1994, with emphasis on recent literature. Available evidence suggests that the prevalence of psychopathology among children in family foster care is higher than would be expected from normative data, even when this population is compared with children who have backgrounds of similar deprivation. As for the types of psychopathology in this population, the only apparent trend is the predominance of externalizing disorders, such as disruptive behavior disorders. A combination of social, psychological, and biological factors may render children in family foster care highly vulnerable to psychopathology.

Contact between children in foster and residential care and their birth families have an impact on children’s development and on placement stability. Contact is also important for their social relationships and sense of belonging and well-being. The aim of this study was, from children’s point of view, to describe, analyse and compare contact in residential care and foster care in terms of its frequency, visit location, feelings during and after the visits, visit difficulties, happiness with their placement, their self-confidence, future perception about their lives, and perception of their subjective well-being. We used a sample of 145 children in residential care and all the children in foster care (39), aged between 11 and 15, from the same four Portuguese districts. Results indicated that children in residential care had more contact and visits with their parents than children in foster care, being phone calls the most used way to contact the children. The majority of the children presented joy or satisfaction during parents’ visits and more diffuse feelings after the visit. Also, most of children would like to have more visits and just a minority present some difficulties in their fulfilment. Nevertheless, children in foster care had more self-confidence, optimism in relation to their future, happiness in relation to their placement and higher subjective well-being than children in residential care. In summary, it seemed that the type of placement for children at risk is more important to their future than the existence of contact with their parents.

The prevalence of fetal alcohol spectrum disorder (FASD) has been reported to be disproportionately high among children in foster care compared with the general population. However, updated prevalence estimates of infants and children with FASD in foster care or the prevalence of placement of children with FASD in foster care make this unclear. This study examines two questions. Firstly, what is the prevalence of FASD among infants and children in foster care? Secondly, what is the likelihood of placement in foster care for infants and children with FASD? This review was designed using PRISMA-SCR and JBI scoping review guidelines. Three databases were searched for the period June 2012 to June 2023: PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Google Scholar for all countries. Overall prevalence estimates were calculated using a complementary log-log link model along with 95% confidence intervals. Firstly, the estimated prevalence of FASD among infants and children in foster care was 18.8%. Secondly, among children diagnosed with FASD 30.5% are placed into foster care, reflecting greatly increased risk of placement of infants and children with FASD in foster care. We conclude that routine screening for FASD is needed to improve the identification of infants and children with FASD. Increased attention is also needed on developing strategies for FASD prevention. Recognition that nearly one of every three children with FASD will enter foster care demonstrates the need for increased funding, enhanced training and greater availability of services for families and children impacted by FASD.

Outcomes of Adoption of Children with Special Needs

This study examined a path model that postulated intergenerational relationships between biological parent psychosocial functioning and foster care alumni mental health, economic status, and social support; and from these to the likelihood of children of foster care alumni being placed in foster care. The sample included 742 adults who spent time in foster care as children with a private foster care agency and who reported having at least one biological child. A full pathway was found between poorer father's functioning to greater alumni depression, which was in turn associated with negative social support, and then a greater likelihood of child out of home placement. Other parent to alumni paths were that poorer father functioning was associated with alumni anxiety and PTSD, and poorer mother's mental health was associated with PTSD; however, anxiety and PTSD were not implicated as precursors of foster care placement of the child. Findings support the need for increased practice and policy support to address the mental health needs of parents of children in or at risk of foster care, as well as the children themselves, as family history may have a lasting influence on quality of life, even when children are raised apart from biological parents.

Cross-border placement of children is addressed by the 1996 Hague Child Protection Convention, which is binding on the United Kingdom, and in EU law. The detailed procedures are governed by the domestic law of each country involved. However, it was not until 2018 that proceedings for placement of children in foster care by foreign authorities were introduced to Polish law. The fact that cross-border placements have become increasingly common has contributed significantly to the enactment of the new law. The available official data indicate that the British and German authorities are the most inclined to place children with Polish citizenship in foster care in their homeland. Although the regulations introduced in 2018 concern the basic rights of children, they have not yet been presented in detail to the involved parties abroad, including British local and central authorities, judges and social workers. Their familiarity with the relevant provisions of Polish law can undoubtedly contribute to speeding up the proceedings and ensuring that their outcome is harmonious with the best interests of the child.

1. Moira Szilagyi, MD, PhD* 1. *Starlight Pediatrics, Rochester, NY. In September 2010, 408,425 children and adolescents resided in foster care. Recent legislation highlights an increasing focus on involving pediatricians in supporting children in foster care and defines specific requirements relevant to the role of pediatricians. After completing this article, readers should be able to: 1. Understand the purposes of foster care and the problems associated with pre-placement childhood trauma and foster care placement. 2. Know the basics of how foster care systems work. 3. Recognize that children in foster care are by definition children with special health-care needs. 4. Understand that many children in foster care have behavioral problems that can lead to placement instability that, in turn, can exacerbate those problems. 5. Understand the physician’s role in foster care. Foster care is intended to provide a temporary haven for children during a time of family crisis when children are at imminent risk for harm. The goals of foster care are to promote child health, safety, permanency, and well-being. Foster care also has the mission of building on family strengths and providing birth parents with the services they need to reconnect (reunify) with their children. Because children fare best in stable and nurturing families, there has been an increased emphasis in the past decade on shortening the time to permanency through reunification, placement with relatives, and adoption. Foster care also has the obligation to prepare youth for independent living when none of these permanency options is possible. In some states, more than one third of children in foster care are in court-ordered (formal) kinship placements, arrangements in which the related (kin) caregiver may or may not be a certified foster parent. Even outside the child welfare …

P-320 - Trauma and sings of psychopathology in children in foster and institutional care