Foster Care Program Research Articles

Comparing Outcomes for Youth Served in Treatment Foster Care and Treatment Group Care

This study compared youth in the Florida Medicaid system prior to entry into treatment foster care or treatment group care, and compared outcomes in the 6 months after treatment. Florida Medicaid data from FY2003/04 through 2006/2007 along with Department of Juvenile Justice, Department of Law Enforcement, and involuntary examination data were used to examine youth receiving out-of-home treatment. Propensity score matching was used to examine the effect of out-of-home treatment on outcomes. Males, older youth, and youth with prior involuntary examinations, felony charges, misdemeanor charges, or inpatient psychiatric treatment were more likely to be placed in treatment group care. Treatment foster care placement was more likely for youth with prior treatment foster care episodes. Propensity matching results indicated that youth in treatment foster care had greater reductions in felony charges, and were less likely to return to out-of-home treatment in the following 6 months. While often placed in group care settings, youth with prior criminal justice encounters, especially for felony charges, may be better served in treatment foster care programs.

Foster placement disruptions associated with problem behavior: Mitigating a threshold effect.

Placement disruptions have adverse effects on foster children. Identifying reliable predictors of placement disruptions might assist in the allocation of services to prevent disruptions. There were two objectives in this study: (a) to replicate a prior finding that the number of daily child problem behaviors at entry into a new foster home predicts subsequent placement disruptions in foster preschoolers and (b) to determine whether this association is mitigated by a treatment foster care intervention. Problem behavior and placement disruptions were examined in 60 children in regular foster care (age range = 3.10-5.91 years [M = 4.34, SD = 0.83], 58.3% male, 93.4% Caucasian) and 57 children in a treatment foster care program (age range = 3.01-6.78 years [M = 4.54, SD = 0.86], 49.1% male, 82.5% Caucasian). Using the Parent Daily Report Checklist (Chamberlain & Reid, 1987), a brief telephone interview, foster caregivers reported problem behavior 6 times over 3 months. Placement disruptions were tracked over 12 months. The regular foster care children with 5 or fewer problem behaviors were at low risk for disruption, but their risk increased 10% for each additional behavior (p = .013). The intervention appeared to mitigate this "threshold effect"; number of problem behaviors did not predict risk of placement disruption in the treatment foster care group (p = .63). These findings replicate previous evidence linking child problem behavior to placement disruptions and further highlight the need for early preventative interventions.

California Ballot Initiative to Raise Earmarked Funds for the Foster Care System

While recent proposals in the California legislature have been successful in adding nominal dollars to the foster care system, a more radical and comprehensive initiative must be undertaken to address the issue of inadequate foster care funding in the state. Perhaps the only issue more disconcerting than the lack of resources is the looming threat to existing resources. The federal mechanisms which provide the bulk of funding for foster care services are exceedingly vulnerable to curtailment. Consequently, the resource problem afflicting the foster care system is two-fold: (1) An under funded system is providing limited and substandard care to foster youth and (2) the federal funding mechanisms providing the bulk of existing funds will soon face challenges. Work must be undertaken to provide additional and stable sources of funding to ensure the viability of existing services and to facilitate the implementation of new services for this underserved community. The long-standing “scattered” and “reactive” nature of policy making in this field makes it imperative that advocates take an aggressive grassroots posture to proactively improve and protect foster care services before they are completely crippled.This proposal seeks to introduce a ballot initiative to impose a 3.5% monthly internet access fee for all high-speed data lines servicing businesses and residences in California. The funds raised would be earmarked for new foster care services and programs in the state. Unused funds would be placed in a reserve account earmarked for future foster care services.

Service Process and Quality in Therapeutic Foster Care: An Exploratory Study of One County System

ABSTRACT This study assesses the quality of services in the therapeutic foster care programs used by one county in the Midwest. Using a consultative quality assurance review methodology, evaluators examined 67 randomly sampled cases across seven agencies to assess the service quality issues experienced by children. Following interviews with staff, foster parents, and children, and a review of case records, reviewers observed failures in service and in adherence to national program model standards and state regulations. The research indicates the need for consistent monitoring of child-placing agencies and the need for additional research linking service quality with foster care outcomes.

Multidimensional treatment foster care as a preventive intervention to promote resiliency among youth in the child welfare system.

Demographic trends indicate that a growing segment of families is exposed to adversity such as poverty, drug use problems, caregiver transitions, and domestic violence. Although these risk processes and the accompanying poor outcomes for children have been well studied, little is known about why some children develop resilience in the face of such adversity, particularly when it is severe enough to invoke child welfare involvement. This paper describes a program of research involving families in the child welfare system. Using a resiliency framework, evidence from 4 randomized clinical trials that included components of the Multidimensional Treatment Foster Care program is presented. Future directions and next steps are proposed.

Children in Foster Care: Adverse Childhood Experiences and Psychiatric Diagnoses

This study examined psychiatric diagnoses and adverse childhood experiences in a matched sample (n = 144) of children enrolled in standard or treatment foster care programs and their associations with discharge placement restrictiveness for children (n = 90) in treatment foster care. Medical record data were extracted on psychiatric diagnoses, adverse childhood experiences, and discharge placement restrictiveness. Children in treatment versus standard foster care had significantly more psychiatric diagnoses and adverse childhood experiences. The presence of bipolar and opposi-tional defiant disorder was associated with a more restrictive discharge placement. Even without standardized screening, children with more severe presentations are found in treatment versus standard foster care. These findings support the need for coordinated mental health services in treatment foster care.

Evidence-based treatments for trauma among culturally diverse foster care youth: Treatment retention and outcomes

This study describes the implementation of three evidence-based treatments addressing traumatic stress symptoms within a wraparound foster care program in Illinois. Child–Parent Psychotherapy (CPP), Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), and Structured Psychotherapy for Adolescents Responding to Chronic Stress (SPARCS) were implemented with a racially diverse sample of youth ages 3–18 at six agencies. Culturally sensitive adaptations were made to treatment approaches to improve client retention and outcomes. Data analyses revealed no racial differences in retention in the program and no differences in outcomes between minority youth exposed to the intervention and other participants. All three evidence-based treatments were effective in reducing symptoms and improving functioning among minority youth. Implementation issues, including challenges and culturally competent accommodations, are discussed.

BENEFITS AND COSTS OF INTENSIVE FOSTER CARE SERVICES: THE CASEY FAMILY PROGRAMS COMPARED TO STATE SERVICES

The foster care system attempts to prepare children and youth who have suffered child maltreatment for successful adult lives. This study documents the economic advantages of a privately funded foster care program that provided longer term, more intensive, and more expensive services compared to public programs. The study found significant differences in major adult educational, health, and social outcomes between children placed in the private program and those placed in public programs operated by Oregon and Washington. For the outcomes for which we could find financial data, the estimated present value of the enhanced foster care services exceeded their extra costs. Generalizing to the roughly 100,000 adolescents age 12‐17 entering foster care each year, if all of them were to receive the private model of services, the savings for a single cohort of these children could be about $6.3 billion in 2007 dollars. (JEL D61, H75)

At-risk Mothers' Parenting Capacity: An Epistemological Analysis of Change Through Intensive Intervention

Using an epistemological framework, we examine the process of change for two at-risk mothers participating in the Children's Ark, an innovative foster care program. The Children's Ark invited at-risk mothers who had lost custody of their children to live in a structured, supervised environment with their infants/toddlers while receiving intensive intervention. Focusing on two mothers who completed the program and regained custody of their children, we developed a coding system from Women's ways of knowing (Belenky, Clinchy, Goldberger, & Tarule, 1986) to analyze entry and discharge interviews, and as a means of exploring alternative conceptualizations to the helping professions' understanding of at-risk families. In terms of an epistemological framework, we found that mothers increased their capacity to acknowledge their own minds and voices and those of their children. Additionally, mothers came to recognize their capacity to generate knowledge, especially through dialogue and relationships with others. In conclusion, we discuss the utility of an epistemological perspective in describing and exploring change in at-risk mothers, including possible implications for practice.

Identity Development in Emancipated Young Adults Following Foster Care

This qualitative study explored the experiences of 12 youth who were emancipated from state‐sponsored foster care at age 18 and attempted to establish themselves independently. The findings were analyzed through the lens of two developmental theories: separation/individuation and relational/cultural. Interview data revealed that the often‐difficult experiences of emancipating from foster care influenced an evolving sense of self. Participants identified strongly with self‐sufficiency and help‐avoidance and reported an inaccessibility of peer support. Although much of the current literature focuses on critiques of public foster care programs, this study provides insights into how youth have been personally affected by emancipation. It also contains implications for social work practice with emancipated and soon to be emancipating youth.

Quality of Foster Care May Determine Future Mental Health

Back to table of contents Previous article Next article Clinical & Research NewsFull AccessQuality of Foster Care May Determine Future Mental HealthJoan Arehart-TreichelJoan Arehart-TreichelSearch for more papers by this authorPublished Online:18 Jul 2008https://doi.org/10.1176/pn.43.14.0017aChildhood abuse and neglect can have a pernicious impact on mental health later in life, a large volume of research has found. Moreover, a high rate of child abuse and neglect in the United States has contributed, in part, to the large number of youth in foster care.Yet investigators do not appear to have conducted a controlled study on the impact of foster care on the long-term mental health of abused or neglected youngsters, Ronald Kessler, Ph.D., a professor of health care policy at Harvard Medical School, and his colleagues found. So they decided to take on the challenge themselves. (Kessler also headed the National Comorbidity Survey Replication, which was published in 2005.)They compared the mental health outcomes of 368 adults who had received care as adolescents in two public-sector foster-care programs with the outcomes of 111 adults who had received care as adolescents in a private foster-care program called the Casey program. All subjects had been placed in foster care primarily because of maltreatment, and all had been out of care from one to 13 years at the time of the study.The Casey program had provided not only more highly trained personnel and more intense services than the public programs, but also additional funds to foster parents and even postsecondary job training or a full college education to all participants. Turnover of foster parents and case-workers had also been substantially lower in the Casey program than in the public ones, resulting in more stability for participants.Not unexpectedly, the Casey alumni seemed to have better mental health than public-program alumni. Specifically, in the year prior to the study, the Casey alumni had experienced significantly less anxiety, significantly less major depression, and significantly fewer substance-use disorders than the public-program alumni. Casey alumni also seemed to have better physical health—they had experienced significantly fewer ulcers and significantly less diabetes, high blood pressure, and heart disease.“Public-sector investment in higher-quality foster-care services could substantially improve the long-term mental and physical health of foster-care alumni,” Kessler and his team reported in the June Archives of General Psychiatry.However, before states invest in a Casey-model foster-care program, the investigators cautioned, more analysis is needed “because we are not sure that all of the more costly elements of the Casey package of services contribute[d] to the greater effectiveness of the Casey program.”Also, states might want to include cognitive-behavioral therapy (CBT) in a model foster-care program, the investigators proposed, since “CBT designed specifically to treat the emotional scars of child abuse and trauma” was not available in the Casey program, but has since been developed. And states should also explore other private foster-care programs besides the Casey one before deciding on a model foster-care program, the researchers advised, since there are many throughout the United States.In an accompanying editorial, Charles Nemeroff, M.D., chair of psychiatry at Emory University, also made a novel suggestion—that researchers should examine whether optimal foster care can improve the mental health of maltreated youngsters who possess the SS variant of the serotonin gene. Past research has shown that the SS variant, when combined with child abuse, confers a particularly heightened vulnerability to depression, but psychosocial support can reduce the risk.The study was funded by an unrestricted grant from the Casey Family Programs as well as by the states of Oregon and Washington, which is where the foster-care programs that were studied were located.An abstract of “Effects of Enhanced Foster Care on the Long-Term Physical and Mental Health of Foster Care Alumni” is posted at http://archpsyc.ama-assn.org/cgi/content/abstract/65/6/625.▪ ISSUES NewArchived

Use of the Brief Psychiatric Rating Scale-Children (BPRS-C) as an Outcomes Measure in the Residential and Foster Care Setting

SUMMARY Studies that have used the Brief Psychiatric Rating Scale for Children (BPRS-C) and reported findings in the literature have done so in severely ill populations. We elected to determine the usability of the tool on clients in three residential and foster care settings, where symptoms are not as severe as in the hospitalized population. Two questions were examined: Can the BPRS-C be used as a pre/post outcomes measure outside of the inpatient setting? And, can the BPRS-C detect baseline symptom differences (validity) between three residential treatment cohorts and foster care program clients. A prospective study collected BPRS-C data, which is used as our standard outcomes measure. The tool was administered in three levels of residential care (n = 522) and foster care (n = 396) clients at program admission and discharge. Client ages were from 4 to 18. Significant pre/post differences were found on residential client cohorts on all seven subscales, indicating improvement. These significant results were observed in all three residential care settings. For foster care clients, no change or significantly deteriorating conditions were observed on all BPRS-C subscales. This research indicates that the BPRS-C was effective at demonstrating significant condition improvement in the three residential settings tested. The data suggest that the tool can be used as an outcomes measure. Foster care clients demonstrated no condition improvement, possibly due to a floor effect, as admission scores on the BPRS-C were very low. The BPRS-C was found to not have use in this population.

Effects of Enhanced Foster Care on the Long-term Physical and Mental Health of Foster Care Alumni

Child maltreatment is a significant risk factor for adult mental disorders and physical illnesses. Although the child welfare system routinely places severely abused and/or neglected children in foster care, no controlled studies exist to determine the effectiveness of this intervention in improving the long-term health of maltreated youth. To present results of the first quasi-experimental study, to our knowledge, to evaluate the effects of expanded foster care treatment on the mental and physical health of adult foster care alumni. We used a quasi-experimental design to compare adult outcomes of alumni of a model private foster care program and 2 public programs. The latter alumni were eligible for but not selected by the private program because of limited openings. Propensity score weights based on intake records were adjusted for preplacement between-sample differences. Personal interviews administered 1 to 13 years after leaving foster care assessed the mental and physical health of alumni. A representative sample of 479 adult foster care alumni who were placed in foster care as adolescents (14-18 years of age) between January 1, 1989, and September 30, 1998, in private (n = 111) or public (n = 368) foster care programs in Oregon and Washington. More than 80% of alumni were traced, and 92.2% of those traced were interviewed. Caseworkers in the model program had higher levels of education and salaries, lower caseloads, and access to a wider range of ancillary services (eg, mental health counseling, tutoring, and summer camps) than caseworkers in the public programs. Youth in the model program were in foster care more than 2 years longer than those in the public programs. Private program alumni had significantly fewer mental disorders (major depression, anxiety disorders, and substance use disorders), ulcers, and cardiometabolic disorders, but more respiratory disorders, than did public program alumni. Public sector investment in higher-quality foster care services could substantially improve the long-term mental and physical health of foster care alumni.

Teaching and Learning Guide for: Assessing Welfare Reform, Over a Decade Later

Teaching and Learning Guide for: Assessing Welfare Reform, Over a Decade Later

Linking data to decision-making: applying qualitative data analysis methods and software to identify mechanisms for using outcomes data.

A multiple case study was conducted to examine how staff in child out-of-home care programs used data from an Outcomes Management System (OMS) and other sources to inform decision-making. Data collection consisted of thirty-seven semi-structured interviews with clinicians, managers, and directors from two treatment foster care programs and two residential treatment centers, and individuals involved with developing the OMS; and observations of clinical and quality management meetings. Case study and grounded theory methodology guided analyses. The application of qualitative data analysis software is described. Results show that although staff rarely used data from the OMS, they did rely on other sources of systematically collected information to inform clinical, quality management, and program decisions. Analyses of how staff used these data suggest that improving the utility of OMS will involve encouraging staff to participate in data-based decision-making, and designing and implementing OMS in a manner that reflects how decision-making processes operate.

Increasing Safety for At-Risk Adults: Screening In-Home Care Providers

Years ago, the director of a program for adults with developmental disabilities asked me to teach a workshop for staff after a male aide molested a wheelchair-bound client in a bathroom. A head nurse at a hospital for frail elders asked for a workshop after a stroke patient was diagnosed with a sexually transmitted disease. Why me? I asked the people extending these generous invitations. Good question--my field is child welfare. Everybody else refused, they answered. Bad answer. From my perspective as a child welfare social worker, I see unnecessary gaps in screening and hiring practices for in-home helpers who work with dependent adults and frail elders. I have heard the justifications for the status quo from consumers, client advocates, and agency directors and find them unpersuasive and unnecessarily dangerous. PREREQUISITES FOR WORK WITH MINORS People wishing to work with children in health and mental health programs, schools, child care, foster care, group homes, and residential programs must submit fingerprints to their prospective employer who, in turn, sends them to the state's Department of Justice for clearance. The clearance includes juvenile court and child protective services cases as well as criminal convictions (Goldman & Salus, 2003; Howell, 1993; Lockyer, 2000). The former may be more relevant than a Department of Motor Vehicles (DMV) or criminal background check because the triggers (for example, crying, enuresis, defiance, and temper tantrums) that lead a parent to abuse a child are apt to abound in work with children. Once hired, employees must be informed of their responsibilities under the child abuse reporting laws and agree to report reasonable suspicions of abuse or neglect promptly to the appropriate protective agency. They must sign a statement saying they know they are mandated by law to report suspected child abuse and neglect, understand what constitutes abuse and neglect, and know how and when to report their reasonable suspicions. The employer must keep the fingerprint clearance and this signed statement in the employee's personnel file. Most states require more extensive training for those applying for social work, marriage and family therapy, and clinical psychology licenses (Goldman & Salus, 2003; Howell, 1993). Whenever there is a question about omissive or comissive behavior by an employee or an agency, an investigator's first move is to check the personnel files for fingerprint clearances and reporting law agreements. That is not to say that people seeking to victimize children do not scale these hurdles--far too many do--but, as hurdles go, they are good deterrents. Prospective employees must be fingerprinted and pay the nominal fee the police, sheriff, and DMV charge, usually about $15. Each state's Department of Justice charges the employer approximately $75 to $85 per candidate to run the scans. Agencies, even child care agencies operating on shoestring budgets, are expected to include this expense in their budgets as a reasonable and necessary cost of doing business. Child welfare is committed to preserving family ties for at-risk children (National Council of Juvenile and Family Court Judges, Child Welfare League of America, Youth Law Center, & National Center for Youth Law, n.d.) and waives many requirements for relatives providing child and foster care that would be mandatory for nonrelatives doing the same work. This double standard aims to keep families together with minimal assurances of safety and raises the bar considerably for nonrelatives wishing to become foster parents or to work with children in day care centers, schools, and therapeutic programs. WORKING WITH AT-RISK ADULTS In adult services, the landscape is very different. Some people contact an agency for helpers and generally rely on the agency to screen staff. Many agencies have improved their screening in the past several years, but consumers cannot assume that agencies do more than contact references and perhaps the DMV. …

Community Child and Adolescent Psychiatry: A Manual of Clinical Practice and Consultation

Back to table of contents Previous article Next article Book ReviewFull AccessCommunity Child and Adolescent Psychiatry: A Manual of Clinical Practice and ConsultationMatthew Kleban M.D.Matthew Kleban M.D.Search for more papers by this authorPublished Online:1 May 2007https://doi.org/10.1176/ps.2007.58.5.719AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Community child and adolescent psychiatry is rife with challenges. Not only are there innumerable agencies and services, each having unique characteristics and cultures, but one's role within any given agency is often not clearly defined. Administrative and clinical responsibilities may overlap, and professional standards may yield to the financial restrictions of the public sector. Whether providing direct services or a consultation, it is imperative for the clinician to have a clear understanding of the system in which he or she operates. With these general principles in mind, Theodore Petti and Carlos Salguero have assembled a multiauthored text to enable clinicians to navigate these complexities.The book is divided into four sections. After an introductory section, the book moves from principles to practice, offering a series of chapters that describe members of an interdisciplinary team. These appropriately credentialed individuals write the corresponding chapters. After outlining their educational background, the authors of these chapters provide information ranging from their theoretical perspectives to their more quotidian functions. As one author advises, the role of the social worker is to "support the parent's caregiving role, not supplant it." Another author cautions psychiatrists about signing documents that are prepared by members of other disciplines.The third section discusses the many types of agencies serving this population: community mental health centers, schools, school-based health centers, foster care programs, child care settings, day treatment centers, chemical dependence programs, residential care programs, and advocacy groups. Some chapters describe administrative and organizational structures, including configurations of governance from director to frontline staff. Other chapters describe operational nuts and bolts, such as developing services and assessing outcomes. This section also includes historical and political background, pertinent legal and ethical issues, and tips on maintaining financial viability in the current mental health care environment. There is some thoughtful emphasis on the need to avoid burnout.The chapter on schools provides a thorough discussion on consultation issues. It addresses how to gain access to local schools and maintain relations with educational staff, and it revisits the pervasive issue of role confusion. As one author articulates, "the goal of the consultative relationship should be to increase the school's autonomy in managing mental health problems and not to increase the school's dependency."Although the book is largely focused on organizational matters, it includes some useful clinical pearls. In the challenging milieu of day treatment, flexibility is stressed. In lieu of traditional individual therapy, observing a child's interactions and implementation of coping strategies in the various group settings may prove to be more illuminating. The chapter on foster care highlights the clinician's need to balance the foster child's attachment difficulties with the foster parents' countertransference-like reactions toward the child.The final section delineates innovative programs and future trends. For instance, it describes how Virginia and Illinois have dealt with the closing of inpatient state-operated facilities, namely by establishing more community-based treatments and shifting care to the private sector. Promising advances include the proliferation of wraparound services and multisystemic therapy, as well as the application of ongoing technological improvements.One could argue that although the title implies a target audience of clinicians already identified as part of the community sector, the true beneficiaries include all mental health professionals working with children and adolescents. Another limitation is that, as with most multiauthored books, there is some inevitable redundancy. Perhaps a few of the chapters are overly theoretical, appealing mainly to those who, like the editors, have backgrounds in public health. Although there is one chapter broadly discussing forensic issues, there is no mention of the juvenile justice system, a notable omission given how closely linked these systems often are. For the most part, however, this book succeeds in providing concise, eminently readable, and clinically useful information about working with children in these various community settings.Dr. Kleban is a staff psychiatrist in the Community Day Hospital, Bronx Children's Psychiatric Center, New York City. FiguresReferencesCited byDetailsCited byNone Volume 58Issue 5 May, 2007Pages 719-720PSYCHIATRIC SERVICES May 2007 Volume 58 Number 5 Metrics PDF download History Published online 1 May 2007 Published in print 1 May 2007

Intervention Effects on Foster Preschoolers’ Attachment-Related Behaviors From a Randomized Trial

This study examined change in attachment-related behaviors among foster preschoolers participating in a randomized trial of the Multidimensional Treatment Foster Care Program for Preschoolers (MTFC-P). Measures of secure, resistant, and avoidant behaviors were collected using a caregiver-report diary at 3-month intervals during the 12 months following a new foster placement. Children randomly assigned to the MTFC-P intervention condition (n = 57) showed significant increases in secure behavior and significant decreases in avoidant behavior relative to children assigned to a regular foster care condition (n = 60). Both groups showed significant decreases in resistant behavior over time. Analyses also revealed a significant interaction between treatment condition and age at first foster placement on change in secure behavior. Results are discussed in terms of the importance of early intervention and prevention services for foster preschoolers.

PERMANENCE FOR OLDER FOSTER YOUTH1

I discuss the importance of permanency for older youth in foster care and the limitations of current foster care programs in meeting the permanency needs of these youth. I provide an overview of federal and state policies and describe recent initiatives that are successfully increasing permanence for older foster youth, overcoming barriers to adoption, and using creative strategies to identify alternative permanent arrangements. A key component is inclusion of foster youth in the decisions that affect their lives.

The Early Intervention Foster Care Program: A Glass Half Full

The Early Intervention Foster Care Program: A Glass Half Full