Foster Caregivers Research Articles

A national dementia care pathway explored and compared

AbstractBackgroundA national, systematic diagnosis and care pathway has the potential to alleviate pressing challenges experienced by individuals with dementia, their carers, and healthcare providers. International exemplars were sought to compare/contrast dementia care with current practice in the United States (US). Specifically, the 2013 New Zealand (NZ) Framework for Dementia Care was explored. The aim was to better understand this systematic, primary care‐led, home and community‐focused dementia management approach from the perspective of those delivering care. To better understand its potential for adoption, US providers were similarly studied.MethodMaximum variation purposive sampling was used in this qualitative descriptive study of 28 participants (18 New Zealand, 10 United States) including providers, case managers/social workers and government officials. Following review and approval by the IRB, investigator‐developed semi‐structured interviews were used, with recruitment of participants continuing until data saturation was reached. Data were then explored for themes using qualitative content analysis, the preferred approach for qualitative descriptive design, and supported by HyperResearch. Throughout the study, qualitative research quality enhancement strategies follow the classic approach of Guba and Lincoln (1994).ResultsNational standards in NZ provide a progressive pathway grounded in early primary care diagnoses and adaptable teams that foster caregiver support to decrease their burden (See Figure 1). The approach also ensures streamlined access to specialists by integrating dementia care in primary care. This is in contrast to the US, where a reactive rather than proactive approach requires providers to navigate unpredictability as they strive to weave together insufficient, inadequate, inconsistent, and inequitable resources to cobble a family’s foundation for an uncertain future.ConclusionCompared to the US where only 2.12% of the Medicare spend is on primary care (Bannow, 2019), NZ is grounded in a strong primary care foundation as are many of the world’s most highly functioning health care systems (Schneider, Sarnak, Squires, Shah & Doty, 2017). Individual states exploring total cost care models, do have the capacity to redesign primary care for enhanced capacity for dementia management both within practice and community settings and should take action. Further implications for translating promising practices to the US are detailed.

Peran Progam Wali Asuh dalam Membentuk Kedisiplinan Santri Pondok Pesantren Al Mahrusiyah Putra Lirboyo

This study used a qualitative approach with field research conducted at Pondok Pesantren Al Mahrusiyah Putra Lirboyo, Kediri City. This study aims to examine the impact of the foster care program in shaping the discipline of students at the Al-Mahrusiyah Islamic Boarding School. This study departs from two research questions, namely how the program carried out by foster caregivers in shaping the discipline of students and how is the impact of the program of foster care in shaping the discipline of students. By using the method of observation, interviews, and documentation the researcher can conclude from the results of the study that the role of foster care is very important to help the success of the boarding school program, especially in terms of forming student discipline. As in the program he established, among others: rote deposits, congregations praying dhuha, pickets of cleanliness. The program that has been compiled by foster caregivers to form student discipline can be said to have been in accordance with the factors that affect a person's discipline, which in contact with these factors will affect the discipline of the students.

Examining the Impact of COVID-19 on Parental Stress: A Study of Foster Parents.

PurposeThe overarching purpose of this exploratory study was to understand how foster parents’ parenting-related stress levels have changed over the course of the COVID-19 pandemic, including the role of sociodemographic characteristics in exacerbating risk for increased stress.MethodParticipants were electronically surveyed about their pre- and post-pandemic parenting-related stress, using an adapted version of the parenting stress scale.ResultsNine-hundred and ninety foster parents (N = 990) participated in the study. Overall, foster parents reported significant increases along three specific domains of stress—namely, parenting stress, lack of control, and parental satisfaction (reverse-scored). Analyses for group differences on the post-only scores indicated that foster parents who are not married, or who report poorer mental health (i.e., “good”, versus “very good” or “excellent”) or financial circumstances (i.e., as indicated by not reliably having more income than expenses) may face increased risk for exacerbated stress during this pandemic.DiscussionFindings from this study indicate that parental stress-levels among foster parents have increased since the start of COVID-19. These findings are not only troubling for foster caregivers, but may also have implications for the youth in their care. Ultimately, results from this study indicate the need to better support foster parents, in general, and during public health crises, specifically.

Foster children’s attachment representations: the role of type of maltreatment and the relationship with birth family

ABSTRACT Children in foster care are at risk of developing insecure and disorganized attachment, which is problematic for establishing new relationships in foster families. However, most previous studies have focused on attachment behaviors in young children rather than on attachment representations. We compared foster children’s attachment representations with those of a community group, analyzing also the contribution made by different factors to foster children’s attachment representations. We assessed the attachment representations of 109 children aged between 4 and 9 years (51 children in non-kin foster care and 58 community children) in southern Spain, using a narrative story stem measure. Case records information were collected for adversity and child protection variables. Foster children had fewer security and more avoidance indicators than their community counterparts, with those who had suffered more severe maltreatment scoring lower for security and higher for disorganization. Exposure to physical and emotional abuse and birth parents’ opposition to the foster placement predicted more disorganized attachment representations. Interventions with foster children should consider their heterogeneity in terms of attachment outcomes, and foster caregivers of abused children may need guidance in order to provide therapeutic caregiving.

Improving behaviors and placement stability for young foster children: An open trial of Parent-Child Care (PC-CARE) in the child welfare system

Abstract Young children in the foster system, who have experienced various traumas, are at risk for mental health problems, particularly externalizing and trauma-related behaviors. Such problems are related to placement instability and future difficulties. Many interventions for foster children take months to implement and tend to target only children with moderate to severe behavior problems. This study presents preliminary findings from a county-wide implementation of Parent-Child Care (PC-CARE), a 7-session dyadic intervention, as a secondary prevention service for all children aged 1–5 years in new foster placements, with the goal of improving children’s behavioral adjustment and placement stability. Method Participants included 153 children aged 1–5 years (50% male) who participated in at least one PC-CARE session with their foster caregivers in the first 90 days of placement. Results Children who completed PC-CARE showed significant decreases in trauma and behavior symptoms and increases in positive behaviors (i.e., initiative, self-regulation), and caregiver-child relationships from pre- to post-intervention. Children who completed PC-CARE showed more placement stability and fewer placements disruptions to another foster home at one- and six-months post-intervention than children who did not complete PC-CARE. Conclusion PC-CARE appears to be a promising secondary prevention service within child welfare associated with improvements in children’s adjustment to new foster placements and increased placement stability.

Children in care of grandparents and non-grandparents: Which have greater odds of high academic performance?

Much literature exists on social, emotional, and behavioral outcomes for children in care of their grandparents (i.e., grandfamilies), however little is known about academic performance among children living in grandfamilies when compared to other types of nonparental care. We conducted a cross-sectional analysis using secondary data from the United States 2013 National Survey of Children in Nonparental Care. We compare the academic functioning in math and reading/writing of school-aged children (N = 809) cared for by grandparents with two other types of nongrandparental caregivers. Using logistic regression models, we found that compared to children in care of their grandparents, children in care of foster caregivers and nonrelatives in nonfoster settings were approximately 45% less likely to have high academic performance in math and reading/writing. With this research we add to the literature on academic performance of children in out of home placement, setting the stage to compare arrangement options.

Family Environment Characteristics and Mental Health Outcomes for Youth in Foster Care: Traditional and Group-Care Placements

Foster care is meant to provide a safe, temporary out-of-home placement for children exposed to maltreatment, yet little is known about how youth and foster caregivers perceive these new foster care environments and how cohesion and conflict within the foster care setting (i.e., traditional or group-care) may be impacting youths’ mental health. It was expected that cohesion would be negatively associated and conflict would be positively associated with youth internalizing and externalizing problems and that placement type (i.e., traditional foster home vs. group-care setting) would moderate the associations. The sample included 481 youth in foster care (Mage = 13.13, SD = 3.10) and their caregivers. Youth completed self-report measures about family conflict, family cohesion, maltreatment exposure, and youth internalizing symptoms. Foster caregivers completed measures on family cohesion, family conflict, and youths’ externalizing symptoms. Results suggested that youth report of family conflict was positively associated with internalizing problems, while caregiver report of family conflict was not associated with youth internalizing or externalizing symptoms. A significant interaction was found between placement type and youth report of family cohesion, indicating that higher family cohesion was associated with lower levels of internalizing symptoms for youth living in traditional foster care homes, but not for those in group-care settings. This study highlights the importance of utilizing multiple reporters, particularly when examining foster care environments. Results showed that family characteristics were differentially associated with mental health outcomes. Findings suggest that family cohesion is particularly salient for internalizing symptoms of youth living in traditional foster homes.

Change in foster parent knowledge, skills and confidence associated with support from a peer “trauma coach”

Background: Foster parents are in an ideal position to build resilience and manage trauma symptoms in the children they care for. Learning about trauma and using effective parenting strategies can mitigate the devastating impact of trauma on the youth. Peer support incorporating psychoeducation and skill building for the caregiver has been demonstrated to promote more accurate interpretation of children’s behavior in some settings. Objective: To identify changes in knowledge, skills and efficacy of foster caregivers who received trauma coach services. Design/Methods: The study was conducted …

Improvements to Foster Caregiver Experiences in Pediatric Hospital-to-Home Transitions.

Improvements to Foster Caregiver Experiences in Pediatric Hospital-to-Home Transitions.

Parenting intervention outcomes for kinship caregivers and child: A systematic review

BackgroundKinship foster caregivers often face serious challenges but lack adequate parenting capacities and resources. The importance of parenting interventions for kinship foster caregivers has been recognized, and researchers have assessed the effect of various parenting interventions on the caregivers and children. However, no systematic review has been conducted to summarize findings related to parenting interventions targeting kinship care. ObjectivesThis study systematically summarizes the effect of parenting interventions on kinship foster caregivers and their cared for children, and examines the intervention strategies and research methods used in order to provide a context in which to better understand effects of interventions. MethodsFrom six academic databases, 28 studies were identified for review. A data template was used to extract the following information from each study: intervention targets, research design, settings, intervention description, outcome measures, and main results for each study. ResultsVarious parenting interventions targeting kinship foster care families have been developed to improve parenting capacities and reduce parental stress. Most of the interventions had a positive impact on the outcomes of both caregivers and children, although the assessed outcomes often differed across studies. Parenting interventions improve caregivers’ parenting competency, reduce parental stress, and advance child wellbeing. However, some interventions appear less promising in achieving targeted goals. DiscussionThe findings suggest that promoting evidence-based parenting interventions with a special focus on kinship care is important for child welfare. Future directions for research are also discussed in this study.

Emotion Regulation among Children in Foster Care Versus Birth Parent Care: Differential Effects of an Early Home-Visiting Intervention.

Children involved with Child Protective Services (CPS) often show worse emotion regulation than non-involved children, with downstream effects on adaptive functioning. The current study uses two randomized control trials, one conducted with foster caregivers and one conducted with birth parents, to investigate the longitudinal effects of caregiver type (foster versus birth parent) and a home-visiting parenting intervention on emotion regulation among young children referred to CPS. Participants were 211 children referred to CPS during infancy or toddlerhood, of whom 120 remained with their birth parents and 91 were placed in foster care. Caregivers were randomly assigned to receive Attachment and Biobehavioral Catch-Up (ABC), a 10-session intervention designed to promote nurturing, sensitive, and non-intrusive caregiving, or a control intervention. Caregiver type moderated the effects of ABC on young children's observed anger dysregulation during a frustrating task at age 2 to 3years. Among children remaining with their birth parents, children whose caregivers received ABC showed lower anger dysregulation than children whose caregivers received the control intervention. Children placed in foster care showed lower anger dysregulation than children with birth parents regardless of parenting intervention, and additionally showed higher adaptive regulation than children remaining with their birth parents. Adaptive regulation was not significantly associated with parenting intervention or the caregiver by intervention interaction. Results suggest that foster care placement may be protective for emerging emotion regulation skills among young children referred to CPS, and an attachment-based parenting intervention buffers risks of remaining in the home for young children's emotion dysregulation.

Perspectives on Informed Consent Practices for Minimal-Risk Research Involving Foster Youth.

* Abbreviations: GAL — : guardian ad litem IRB — : institutional review board There are >430 000 children in protective custody (ie, foster care) in the United States.1 Despite known health disparities,2–5 there continues to be limited research to develop an evidence base for diagnosing and intervening to improve health conditions for children in foster care.6 One identified obstacle to recruitment is obtaining informed consent, the legal requirement for understanding and voluntary agreement to participate in research. Foster youth do not have a traditional parent or guardian and instead have many adults playing different roles in their lives, including their children’s services caseworker, their foster caregiver, their biological parent, their court-appointed special advocate or guardian ad litem (GAL), and their judge or magistrate. Each plays a role in decision-making for the child and could participate in the informed consent process. Previous work has demonstrated inconsistent approaches for obtaining informed consent for youth in foster care to participate in minimal-risk research; a review of 49 publications revealed 14 different combinations of individuals used for informed consent, ranging from judge, caseworker, and caregiver consent with youth assent to biological parent consent only.7 For pediatric researchers wanting to develop evidence-based health guidelines and interventions for this population, obtaining consent from a legally empowered guardian for foster youth may appear to be an insurmountable barrier. Consensus would be beneficial to promoting research … Address correspondence to Mary V. Greiner, MD, MS, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, ML 2011, Cincinnati, OH 45229. E-mail: mary.greiner{at}cchmc.org

A new kinship typology and factors associated with receiving financial assistance in kinship care

Financial hardship is one of the most challenging issues faced by kinship foster care families. Temporary Assistance for Needy Families (TANF) benefits and foster care payments are potential sources of financial assistance for kinship families. This study used wave 2 of the National Survey of Child and Adolescent Well-Being II (NSCAW II) to develop a new typology of kinship care based on financial mechanisms, including: (1) families that received TANF only (TANF only); (2) families that received foster care payments only (FC only); (3) families that received both TANF benefits and foster care payments (TANF + FC); and (4) families that received no payments (None). This study further divided the None group into two subgroups: None + Below Poverty and None + Above Poverty. To examine factors associated with receiving TANF and foster care payments, results from logistic regression analyses indicated that maltreatment type, children’s externalizing problems, married caregivers, and receiving social services were significantly associated with receiving foster care payments. Living below the federal poverty line and in a single-adult household were associated with receiving TANF benefits. Additionally, this study found that children of other race/ethnicity, such as Asian/ Pacific Islanders or Native American families, children’s internalizing problems, and employed caregivers were associated with lower odds of receiving foster care payments. Being a licensed foster caregiver was associated with lower odds of receiving TANF benefits. The results suggest that child welfare workers and policy makers should consider how to increase kinship caregivers’ awareness of financial resources and to make appropriate resources accessible for kinship caregivers.

Fostering healthy families: An exploration of the informal and formal support needs of foster caregivers

This qualitative study examines the challenges foster caregivers face within their families and seeks to understand their formal and informal support systems so that future trainings may be created to provide for the specific and realistic needs of foster caregivers. Twelve licensed foster caregivers from North Carolina took part in 90 minute focus groups with semi-structured questions regarding relationship strengths and challenges, trainings, and support. Six themes were inductively coded from the data: quality of supports and people who understand, strain on family relationships, fear of removal, lack of support from systems, lack of applicable training, preparation and support for adoption; examples of each are provided. Increasing numbers of children in foster care, combined with a lack of available foster placements makes recruitment and retention a vital factor for those who train and work with foster caregivers; our research indicates a strong need for appropriate and applicable foster caregiver trainings, combined with support from both formal and informal systems.

32. Training Foster and Kinship Caregivers as a Strategy to Reduce STI and Pregnancy Risks in Foster Youth: Results from a Randomized Controlled Trial

32. Training Foster and Kinship Caregivers as a Strategy to Reduce STI and Pregnancy Risks in Foster Youth: Results from a Randomized Controlled Trial

An exploration of placement-related psychosocial influences on school engagement among adolescents in foster care

There is ample evidence that experiencing foster care in childhood often predicts grim outcomes in adulthood, including under-education and resulting poverty and dysfunction. However, little is known about the exact mechanisms through which foster care corrodes academic trajectories, specifically. The current study uses a nationally representative sample of adolescent foster youth (i.e., NSCAW II) to test a model of the influences of placement-related factors on school engagement – namely, foster youth’s perceptions of security in their foster placements, their reports of education-specific involvement by foster caregivers, and the mediating potential of adolescents’ expectations for their future. Results indicate that adolescents’ feelings of “placement security” were linked to their future expectations of positive life outcomes and, ultimately, school engagement. Results also suggest that while educational involvement by foster caregivers was not important for future expectations or social school engagement, it may be related to the more explicitly cognitive aspects of school engagement (i.e., assignment completion, effort, etc.). These findings offer insight into relations between foster care-specific factors and school engagement – a known predictor of academic achievement and eventual educational attainment. Implications for future research and practice are discussed.

‘In my heart forever:’ Foster caregivers’ dedication, grief, and couple relationship quality

ABSTRACT Many dedicated foster caregivers form a strong attachment to the children in their care, leaving them emotionally at-risk for when a child is removed from the home (e.g. displacement, reunification). The grief they experience when a child leaves may influence their other relationships (e.g. couple relationship). Survey data were collected from a statewide random sample of foster caregivers. The final sample included foster caregivers who had experienced the removal of a foster child from their home within the previous 12 months of participating in the study (n = 56). A moderated mediation analysis was conducted to determine the associations between dedication to fostering, grief, couple relationship quality, and relationship efficacy. Findings suggest that highly dedicated foster caregivers are more likely to experience higher levels of grief after a child leaves their home, which is negatively associated with their couple relationship quality. However, relationship efficacy was found to buffer these effects.

FOSTERING DEMENTIA-FRIENDLY COMMUNITIES AND SUPPORTING CAREGIVERS THROUGH THE GWEP PROGRAMS

As the number of people affected by dementia increases, it is essential that caregivers are provided resources and communities educated on how to engage and support people living with dementia. Supporting caregivers and providing education about dementia-friendly communities are key components of the Geriatric Workforce Enhancement Programs. This symposium will provide examples of GWEP projects which foster dementia-friendly communities and support caregivers. Additionally, recent and current legislation targeting dementia and caregivers will be presented.

Companion Dog Foster Caregiver Program for Older Veterans at the VA Maryland Health Care System: A Feasibility Study.

Veterans experience mental health conditions at a disproportionate rate compared to their civilian counterparts, and approximately 60% of older veterans who receive their care through the United States Department of Veterans Affairs (VA) do not meet physical activity (PA) recommendations. We tested the Veterans as Foster Ambassadors program at the VA Maryland Health Care System to examine whether fostering a companion dog would improve PA and function, heart rate variability (HRV), balance, and quality of life (QOL) in older veterans. Participants wore an accelerometer for ≥10 days during each phase (30 day baseline vs. 60 day foster period) to measure daily PA (n = 4). Six-minute walk (6MW) and balance testing (n = 4) and 24 h heart rate (HR) and HRV (n = 2) were determined at baseline and during the foster period. Compared to baseline, there were significant increases in (a) distance during the 6MW, (b) daily steps, and (c) time spent in moderate activity during the foster period. 24 h HR decreased and time- and frequency-domain measures of HRV significantly increased in a veteran with post-traumatic stress disorder during the foster period compared to baseline. All veterans offered positive feedback about the program and indicated that it was beneficial to them. The results from this pilot study provide evidence that fostering a companion dog can improve PA, health, and QOL in older veterans. Future research conducted with a larger sample size to validate the results is warranted.

里親養育不調の危機とその回避のプロセス―医療機関における里子･里親支援のあり方の検討の試み―

里親養育不調の危機とその回避のプロセス―医療機関における里子･里親支援のあり方の検討の試み―