Foster Caregivers Research Articles

The relationship between kinship and foster placement on mental health indicators in children and youth seeking treatment

BackgroundChildren living in both kinship and foster care placements often face considerable adversity. It is possible that these placements can have differential impacts on children’s socioemotional, psychological, and educational outcomes and well-being. ObjectiveThis study examined the similarities and differences between children and youth who reside in kinship placements and those who reside in foster placements. Specifically, similarities and differences in children's mental health care and service requirements, as well as their family's strengths and resources were explored to better understand the needs of children placed in out-of-home care. ParticipantsThe final sample included assessments from 5356 treatment-seeking children, ages three to 18 years old, from across 66 select mental health agencies in Ontario. MethodsChildren were assessed using the interRAI ChYMH, the ChYMH-S, or the ChYMH-DD. These assessments include a variety of embedded evidence-informed scales and algorithms to examine the mental health needs, preferences and strengths of these vulnerable children. ResultsCompared to children in kinship placements, children in foster care were more likely to: (a) exhibit greater externalizing symptoms, (b) display concerns regarding sexual behaviour, (c) encounter trauma, and (d) experience more polyvictimization. No differences were found in terms of spirituality and cultural connectedness. Additionally, kinship caregivers tended to experience greater distress, compared to foster caregivers. ConclusionsFindings from this study highlight important areas where children residing in out-of-home care, particularly those in foster care, require increased access to mental health resources and support. Furthermore, trauma-informed care should always be at the forefront when working with foster and kinship care children and their families.

Who Consents? Medical Decision-Making for Children in Foster Care.

Children in foster care have complexity around medical decision-making because of their unique custody status. When medical decision-making is necessary for a child in foster care, what perspectives are important? What if opinions are not aligned? Who makes the final decision for consent? This Ethics Rounds focuses on a young child in foster care who has had repeated ear infections. Foster caregivers and family of origin are not in agreement on the treatment plan. Two experts, a foster care pediatrician and a child welfare professional, comment on the important considerations for the case, including involvement of legal representation and best interest representation in medical decision-making as well as the variability in child welfare response by state.

Kinship Foster Caregivers, Caseworkers, and Foster parents’ Reflections and Experiences with Placement and Support in Iowa

Kinship foster care has increasingly become the first line of support in child removal cases. Case managers, kinship foster caregivers, and foster parents have perspectives that can inform and enhance services for families and children. The authors investigated the lived experiences of 18 families by conducting 38 qualitative interviews with 20 case managers, 10 kinship foster caregivers, and 8 foster parents. These participants reflected on five themes: starting points for placement, perceptions of and motivations for kinship foster caregiving (e.g., placement considerations, risks in kinship foster caregiving arrangements), informational support (e.g., opportunities, hurdles), barriers and challenges related to support (e.g., financial and instrumental support, child care, respite care), and access to improved social and professional support. The authors describe study limitations, implications for practice, and conclusions.

A Qualitative Analysis About Sexual Health of Foster Teenagers: What Concerns Do Their Caregivers Have?

Abstract Introduction The social environment of children in foster care is one of the factors that impact on their sexual and reproductive development. Understanding these aspects is essential for the development of effective prevention strategies informed by research. Our aim is to explore the primary concerns of caregivers regarding the sexual development of teenagers in foster care. Methods The participants, 24 teenage foster caregivers, aged 32 to 55 years, were recruited through a social service network collaborating with foster families.Three focus groups’ discussion was conducted with foster caregivers using a semi-structured interview between April and June 2023. A qualitative reflexive thematic analysis was employed, focusing on themes related to foster caregivers’ concerns and challenges regarding the sexual development of the foster teenagers. Researchers conducted line-by-line coding inductively using NVIVO 14 software. Results The findings revealed that caregivers are concerned about teenagers’ exposure to sexual risks, challenges in establishing healthy relationship boundaries, dominant behaviors, and early expressions of sexuality. However, certain inaccuracies in attribution and interpretation were identified, which may be attributed to a lack of knowledge and information about normative sexual development, attachment, resilience, and insufficient training as an affective-sexual educator. The participating foster caregivers often linked sexual behaviors and distorted thoughts of teenagers with past childhood experiences. Conclusions The gathered information contributes to a deeper understanding of the needs and deficiencies of this group. Policy Implications This data lays the groundwork for designing more targeted interventions tailored to the needs identified by caregivers, which demand an immediate response.

Stress and Loneliness Among Family Caregivers of Older Persons With Cognitive Impairment: The Mediating Role of Social Isolation and the Moderating Role of Personal Mastery.

Relatively little attention has been paid to the underlying processes and conditions leading to loneliness among caregivers of older persons with cognitive impairment (PCI). Drawing upon the caregiver stress-process model and the social relationship expectations framework, this study examined the mediating role of social isolation and the moderating role of caregiver personal mastery in the association between PCI memory and behavioral problems and caregiver loneliness. Structural equation modeling was applied to cross-sectional data from 266 caregivers in Singapore. Caregiver-reported PCI memory and behavioral problems were associated with increased levels of caregiver loneliness. Caregiver social isolation partially mediated the association and caregiver personal mastery moderated the association. Caregivers with low mastery were more likely to experience loneliness due in part to social isolation resulting from their PCI's memory and behavioral problems. Tailored interventions should address caregiver social isolation and foster caregiver personal mastery.

Foster caregivers in crisis: a comparison study of the perceptions of foster caregivers and child welfare workers

ABSTRACT This qualitative study explored the perceptions of child welfare workers and foster caregivers regarding stress and crises in foster homes. Interviews of foster caregivers (n = 14) and child welfare staff (n = 11) compare the two perspectives to determine similarities and differences. Findings explored stress and various factors contributing to crises. The ability to compare data between groups allowed important distinctions to emerge. Implications for practice include the need for child welfare systems to support professionals with clinical training and expertise to consult with families or child welfare workers in real time and identify ways to strengthen communication between caseworkers and foster caregivers.

Intergenerational conflict, contact with biological parents, and child functioning in kinship caregiver families

Over time, federal child welfare policy has shaped a preference for states to make every effort to place children with kinship caregivers before non-kin, foster caregivers. The current study focuses on two aspects of out-of-home care that past research indicates differ between kin and non-kin foster care arrangements: frequency of conflict between caregivers and biological parents (higher among kin foster care) and children’s contact with biological parents (easier to facilitate among kin foster care). Using a convenience sample of kinship caregivers recruited from a midwestern state, we examined cross-sectional associations between intergenerational conflict, child contact with biological mothers and fathers, and child well-being among kinship care households. N = 205 kinship caregivers completed an extensive telephone interview about a range of relevant topics, including study child well-being (i.e., the child that requires the most care and attention from the kin caregiver). After controlling for a range of caregiver, child, and contextual factors, more frequent intergenerational conflict was associated with a greater likelihood of child hyperactivity disorder, mental health concerns, learning disabilities, and any of the diagnoses individually or in combination. Results concerning child contact with biological mothers and fathers were less conclusive. The findings will add to our understanding of kinship care as a preferred form of non-parental care and have value to those implementing the 2018 Family First Prevention Services Act (H.R. 1892).

Factors influencing caregiver buy-in to early intervention physical therapy.

The family-centered care framework of Early Intervention (EI) has shifted the focus toward caregiver engagement, but the underlying processes that build this are unknown. The aims of this study were 1) to describe the process of caregiver engagement in therapy and (2) to identify factors perceived to influence caregiver buy-in, confidence, and engagement in EI. This preliminary descriptive study utilized quantitative questionnaires and qualitative semi-structured interviews of EI participants (23 caregivers and four physical therapists). Interviews were transcribed and theme coded until saturation was achieved and a concept map was developed. All caregivers believed that their children benefited from EI, that they were empowered and confident in caring for their children, and their quality of life improved based on the quantitative data. The qualitative data revealed that building a rapport and therapeutic relationship is the foundation to developing buy-in. Reciprocal communication is critical to the relationship and the buy-in. Caregiver knowledge and awareness of progress foster caregiver buy-in and confidence once the relationship is established. Improved understanding of the factors influencing the development of buy-in will provide a framework for the clinician to enhance caregiver buy-in. Enhanced buy-in may promote parental engagement and improved outcomes for the child and family.

A prospective study of mental wellbeing, quality of life, human-animal attachment, and grief among foster caregivers at animal shelters.

Foster care programs at animal shelters have emerged as an important tool for promoting animal welfare and supporting shelter life-saving efforts. Preliminary evidence suggests that foster caregiving may also be health-promoting for humans. The goals of this study were to investigate the experiences of foster caregivers at animal shelters based on measures of positive and negative affect, quality of life, and grief, and to describe human-animal attachment among foster populations. Between March 2022 and 2023, 131 foster caregivers from five shelters in the United States completed three online surveys before, during and after providing foster care to a shelter animal. Positive affect decreased significantly from baseline to post-foster (F = 5.71, p<0.01), particularly among dog caregivers (F = 6.17, p<0.01). Negative affect remained unchanged (F = 0.47, p = 0.63). Foster caregivers perceived their foster animal provided companionship, affection and emotional support, although dog foster caregivers reported significantly higher emotional (U = 313.50, p<0.01) and social/physical quality of life (t = 4.42, p<0.01) than cat foster caregivers. Caregivers reported low mean avoidant and anxious attachment, suggesting they were able to develop secure bonds with their foster animals. Retention of fosters was also strong, with 86% of caregivers reporting they were likely to provide foster care in the future. Our findings suggest that fostering at animal shelters may serve as a One Health intervention to offer companionship, affection and emotional support to human caregivers while promoting animal welfare. However, these benefits did not translate to improvements in caregiver mental wellbeing, so caution should be applied when considering foster caregiving as a potential mental health promotion tool.

Foster Parents’ Experiences of Learning within a Supportive and Accessible Program: Connect for Kinship and Foster Parents

This exploratory study evaluated the implementation and pandemic-inspired pivot to virtual delivery of an attachment-based, trauma-informed multi-session program, Connect for Kinship and Foster Parents (CKFP), from the perspective of caregivers of adolescents, across four sites within three provinces in Canada in 2020–2022. Data analysis identified three themes: 1. Experiencing community and connection, 2. Interactive, integrated, and informed learning, and 3. Accessibility and feasibility. While participating in CKFP, foster parents experienced connection with other caregivers and the facilitators and developed knowledge with respect to attachment and trauma, which aided in improved understanding of their teen. Caregivers also indicated that online delivery facilitated their participation. CKFP holds promise in addressing the need for specialized training for foster caregivers of adolescents.

Promoting Healthy Relationships in Foster Care-"If I Had Seen What a Healthy Relationship Looks Like, that Would Have Changed My Perspective".

High levels of intimate partner violence among youth and young adults with history in foster care can perpetuate the cycle of violence and abuse. It is therefore important to understand how the experience of growing up in foster care impacts youths' understanding and formation of intimate relationships. This qualitative study centered the perspectives of young adults and investigated what they learned about relationships through interactions with foster caregivers and child welfare professionals. We conducted semi-structured interviews with 27 young adults and used Consensual Qualitative Research methods to identify critical experiences in foster care and formulate strategies for promoting healthy relationships.

How do kinship and foster caregivers differ in their conceptualization of family connectedness?

BackgroundIn out-of-home care in Australia and internationally, there is an increasing preference to place children in kinship than foster care placements as it is assumed that kinship care promotes caregiver, family, and cultural connectedness. However, little research has examined whether and how the quality of these connections differ between kinship and foster care. ObjectiveWe utilized qualitative methodology to provide a richer, strengths-based exploration of caregivers' perspectives on the caregiver-child relationship and other connections (i.e., family, culture) in kinship compared to foster care. Participants and settingSixty-six kinship (N = 31) and foster (N = 35) caregivers of 8- to 16-year-olds in Australia. MethodsKinship and foster caregivers provided Five-Minute Speech Samples about their child and the caregiver-child relationship. Thematic analysis was used to explore the ways caregivers described family relationships and connectedness. ResultsResults highlighted the value caregivers place on strong attachment relationships with their children and the skills that help them develop a safe haven for children. Caregiver groups also differed in their discussions of commitment to the child and family and cultural connectedness, with kinship caregivers more likely to emphasize the strengths and challenges of birth family relations and the importance of cultural connectedness than foster caregivers. ConclusionsOur findings highlight the ways in which kinship and foster caregivers emphasize different aspects of family and cultural connectedness which can be used to inform policy and practice in an area currently lacking evidence.

Understanding the Motivations of Foster Caregivers at Animal Shelters.

Foster care programs in animal shelters have been shown to benefit animals and shelters, but little is known about what motivates foster caregivers to volunteer. This cross-sectional study explored the motivations and expectations of 131 foster caregivers from five shelters within the United States who completed a pre-foster survey between March 2022 and March 2023. The most common motivations were animal- or community-based, such as the desire to provide an animal with love or do something positive for the community. Ordinal logistic regression models were used to investigate associations between caregivers' motivations and their prior foster experience, pet ownership history, age, gender, and foster animal species. The 18- to 29-year-old caregivers were most likely to expect companionship (OR 5.18, 95% CI 1.79-15.04), emotional support (OR 4.25, 95% CI 1.40-12.89), and to meet other community members through fostering (OR 5.04, 95% CI 1.85-13.74). Male caregivers were less likely to foster for emotional support than females (OR 0.12, 95% CI 0.03-0.48), while dog caregivers (OR 2.23, 95% CI 1.04-4.76) and non-pet-owners (OR 2.66, 95% CI 1.17-6.05) had greater odds of expecting companionship. This study highlights the importance of animal- and community-related benefits for foster caregivers and provides useful direction for shelters wanting to increase recruitment to expand their foster care programs.

Foster Caregiver Experiences: Implications for Retention and Satisfaction

Foster homes promote optimal outcomes among youth who experience difficulties in their original families. However, foster caregivers often face various challenges and difficulties. Guided by ecological framework, the current study examined how multiple factors from foster caregivers’ surrounding environments impact satisfaction and retention among 462 foster caregivers in the United States. Regression analyses suggested that certain demographics, parenting characteristics, and agency characteristics were associated with foster care retention, levels of satisfaction, and overall foster care experience. To probe these findings further, results from latent profile analyses suggested that foster caregivers fell into two profiles—those who experienced a large amount of challenges or few challenges during their time as foster caregivers. On average, those who experienced few challenges reported significantly more satisfaction with foster caregiving, greater intention to continue fostering, and a better overall fostering experience compared with those who experienced more challenges. Implications and limitations are discussed.

Childhood Experiences of Alternative Care and Callousness/Unemotionality: A Conceptual Model, Scoping Review, and Research Agenda.

Individuals with experiences of alternative care (AC; i.e., out-of-home care and institutional care) are at high risk for various mental health and relational problems stemming from exposure to serious attachment disruptions, loss, and complex trauma. Yet, despite the interpersonal context of their significant adversities, surprisingly there is scant research explicitly focusing on callousness/unemotionality (e.g., lack of guilt, callous disregard for others) in this population. This paper provides the first conceptual model for, and systematic scoping review of, callousness/unemotionality in children and young people with experiences of AC. In a comprehensive search of nine databases, 22 articles involving samples of participants in AC or with histories of AC, were identified for inclusion. The pattern of findings revealed that callous-unemotional and psychopathic traits are elevated in children and young people with AC experiences, and positively associated with AC. Moreover, results showed associations between these traits and various psychosocial correlates, most consistently with externalizing and internalizing problems and attachment-related problems. Only two intervention studies were located, one of which found benefits of training and supporting foster caregivers for reducing callous-unemotional traits. These findings are discussed with respect to gaps in the literature, future research directions, and trauma-informed practice to assess and treat callousness/unemotionality in children and young people with experiences of AC.

A trauma-informed intervention for foster caregivers in Central Massachusetts: A mixed methods pilot evaluation

The Encompass program trains and supports foster, kinship, and pre-adoptive caregivers to recognize trauma in children, attend to foster children’s behavioral health needs, and ease the stress of caregiving. We used a caregiver survey at two time points to evaluate the preliminary efficacy of the Encompass program on foster parent (n = 17) and child (n = 25) outcomes, and conducted qualitative interviews with caretakers (n = 15). We observed significant positive changes in caretakers’ perceived knowledge about trauma, confidence in trauma-informed fostering, and use of external support care providers. Qualitative data suggest that participants found the Encompass program to be helpful and enjoyable, but that systemic issues in the child welfare system, which were beyond the scope of this program to impact, contribute to caregiver dissatisfaction and fostering difficulties. Findings suggest that Encompass has a positive impact on caregiver perceptions of knowledge about trauma and confidence in their capacity to provide trauma-informed foster care. Continued evaluation of the Encompass program using an experimental design will be informative about program impact.

Foster caregivers' depressive symptoms and parenting stress: Applying the theory of resilience and relational load

AbstractObjectiveThe aim of the current study was to identify constructive interpersonal behaviors that may make relational partners more resilient while foster caregiving.BackgroundFoster caregiving can be stressful due to the unique demands of the role. Consistent with the theory of resilience and relational load, we propose one possible way for couples to manage stress and promote resilience is by investing in their relationships through repetitive and positive relationship maintenance behaviors.MethodTwo‐parent foster caregiving couples (N = 227) completed online surveys measuring perceptions of their own and their partners' relationship maintenance and conflict management behaviors, as well as individual reports of depressive symptoms and parenting stress.ResultsStructural equation actor–partner interdependence modeling indicated significant direct and indirect actor effects, but no partner effects. Both men's and women's perceptions of the couple's relationship maintenance were positively associated with their perceptions of the couple's conflict management, which, in turn, were negatively related with their own depressive symptoms and parenting stress.ConclusionCouples' prosocial and constructive behaviors are related to lower mental distress in foster caregivers.ImplicationsCouple‐focused interventions may be helpful in promoting behaviors that enhance couple functioning and promote the well‐being of foster caregivers.

Evaluating the impact of facilitated discussion series in improving dementia caregiver stress, resiliency and well‐being

AbstractBackgroundEmotional stress stemming from the complex grief associated with dementia care takes a greater toll on a family caregiver’s health than the physical effort of providing care. Finding Meaning and Hope is a 10‐week workshop for caregivers of persons with dementia, designed to promote understanding of grief and teach self‐care concepts that help mitigate stress. Each video session features Dr. Pauline Boss, author of Loving Someone Who Has Dementia: How to Find Hope While Coping with Stress and Grief, sharing self‐care strategies with real‐life caregivers, and is followed by a facilitator‐led discussion. Home practice activities help caregivers incorporate focal self‐care strategies into their daily lives. This research aimed to assess the relationship between participating in the workshops and caregiver outcomes in stress and well‐being.Methods108 caregivers, 85 percent age 60 and older, completed the workshops during 2019. Two standardized instruments were administered before and after workshop participation: the 12‐item Caregiver Self‐Assessment Questionnaire (American Medical Association, 2015) and the 11‐item Sense of Competence Questionnaire (Vernooij‐Dassen, 2008). Changes in scores were assessed using Analysis of Variance or Difference of Proportions.ResultsParticipation in more than half the sessions had a positive impact on stress management, emotional well‐being, and coping, but fewer gains were made by caregivers with health limitations and those who began the workshops with lower emotional well‐being. The workshops can be strengthened by supporting consistent session attendance and individually tailoring self‐care strategies to caregivers’ unique needs.ConclusionFamily caregivers’ mental and emotional health has been negatively impacted by the COVID‐19 pandemic (Czeisler et al. 2020). Strategies that foster caregivers’ ability to manage stress and bolster well‐being are vital in enabling them to continue care provision during a time when isolation may exacerbate the challenges of caregiving. Interventions like Finding Meaning and Hope offer a promising approach.

0247 Developing and Implementing Sleep Health Education for Foster Care Personnel: A Qualitative Analysis

Abstract Introduction Sleep during childhood has a major impact on physiological, psychological, and cognitive development, yet sleep health is a neglected part of training/education for foster parents and agency staff. This study examined foster care agency staff perceptions of child sleep problems encountered by foster caregivers in order to inform the development of a sleep health training program for foster care agency staff and caregivers. Methods N=36 staff members from public and private foster care agencies in Texas, New York, New Jersey, and Maryland were interviewed remotely. Questions included knowledge of sleep policies, concerns surrounding sleep, methods for addressing sleep concerns, and sleep training recommendations. Two members of the research team coded the interviews using the Atlas.ti program. Coders first independently reviewed and coded transcriptions for thematic key words without formal concepts before reviewing and refining themes/codes with the full research team for consensus. Results Eight interviews were coded for this preliminary analysis, focused on response to the question, “What kinds of questions/concerns/requests have you received from foster caregivers regarding children’s sleep?” Across the 8 transcripts, the code Fear/trauma associated with bed/sleeping (n = 22 occurrences) and Difficulty Sleeping (initiating, maintaining sleep) (n = 18 occurrences) were the most frequently reported concerns. Other codes included: Behavioral issues affecting issues fall asleep (n=11), Placement adjustment impacting sleep (n = 10); Lack of bedtime routine (n = 9); Concerns surrounding medication (n = 7); and Insufficient sleep impacting daytime functioning (n = 5). Conclusion Preliminary findings suggest that sleep training approaches and programs should focus on addressing fear and trauma associated with bedtime and sleeping, as well as establishing a healthy, consistent bedtime routine. Additionally, difficulties with the use of medications, placement adjustment, and behavioral issues manifesting around bedtime should be addressed. Support (if any) This research was funded by the AASMF grant: 266-CS-22.

Effectiveness of group intervention in improving kinship care families’ outcomes: A systematic review of group interventions aimed at kinship caregivers and youth in kinship care

BackgroundDespite the specific needs and challenges that kinship caregivers fostering adolescents face, they still receive less training, monitoring, and social support than non-kinship foster caregivers. Although the effectiveness of interventions and programmes targeting kinship care stakeholders has been previously assessed, a systematic review analysing the effectiveness of group interventions in kinship care outcomes for both kinship caregivers and adolescents in their care is still missing. ObjectivesThis systematic review aims to explore the impact of the group intervention format and to identify which components of this format positively impact kinship care placements that involve youth. MethodsWe identified 13 studies through six databases. The extracted information was displayed through the following categories: location, target of intervention, research design, setting/format of intervention, group intervention description, sample, statistical tests and methods, outcomes, and key findings. ResultsResults revealed that the assessed group interventions aimed to improve parenting skills and social support in kinship caregivers fostering youth. Improvements in both outcomes are likely common in group interventions focused on training parenting skills, with a group size of fewer than ten participants, approximately six to ten group sessions (90 min/session) conducted once a week and implemented interactive activities. Improvements in social support are more likely to be observed for interventions that combined group format and case management. Group intervention benefits relationships with peers, and permanency of the placement in kin youth. DiscussionFindings indicate that more evidence-based group interventions aimed at kinship caregivers fostering youth in kinship care should be designed and assessed to address their specific needs adequately. We have also discussed future research directions and their practicality.