Foster Care Research Articles

A scoping review of randomized controlled trials of parenting and family-based interventions for 10 – 17 year-olds with severe and persistent conduct problems

ABSTRACT Purpose A scoping review of randomized controlled trials (RCTs) of parenting and family-based interventions that aim to reduce severe and persistent conduct problems among 10–17 year-olds. The review also examined feasibility for conducting a network meta-analysis of common therapy elements measured by RCTs. Materials and methods The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA- ScR). Searches were conducted in ERIC, PsycINFO, and MEDLINE without limits on publication year, language or publication country. Study methodological quality was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for RCTs. Results Twenty-five eligible RCTs were identified. The studies trialed nine interventions, with Multisystemic Therapy (MST) being the most evaluated (N = 10), followed by Functional Family Therapy (FFT, N = 4), and Treatment Foster Care Oregon (TFCO, N = 3). Only 10 of the 25 RCTs revealed treatment effect on conduct problems, including 6 of 9 MST, 1 of 4 FFT and all 3 TFCO trials. Discussion Surprisingly few RCTs of parenting and family-based interventions have been carried out exclusively with this population. Available data suggests that MST and FFT have uncertain effectiveness for reducing severe and persistent conduct problems. While the quality of the reviewed studies was generally high, only two reported substantive data on common therapy elements. Conclusion There is need for more RCTs of parenting and family-based interventions delivered for older children and adolescents with severe and persistent conduct problems. Future RCTs should systematically measure common therapy elements with a view to advancing intervention science.

Flourishing After Foster Care: Examining Factors Affecting Flourishing in Transition Age Youth in the United States

Flourishing After Foster Care: Examining Factors Affecting Flourishing in Transition Age Youth in the United States

Through the looking glass; midwifery students' experience of ethical issues: A feminist explanatory case study

BackgroundThe ethical component in midwifery education is governed by international professional values, codes, and ethical principles. The aim of midwifery education is to encourage students to develop a lifelong commitment to ethical practice within their midwifery role and scope. However, little evidence is available on the experiences of midwifery students and how they navigate ethical issues in maternity systems. AimTo present a case study from a midwifery students' perspective that demonstrates observed ethical issues and to provide analysis of the ethical issues identified. DesignA Single explanatory case study design with a feminist lens applied. Explanatory case studies present the ‘how and why’ of a phenomenon and contributes to understanding phenomena in a holistic and real-life context. SettingThis project was set at a West Australian university from which pre-registration midwifery courses are delivered. ParticipantsA solitary case study is presented from a midwifery students' clinical placement. MethodsEthics were approved 2023-04805. Edith Cowan University HREC. The source of data for this case study was direct observation by the primary author (Priya, 2021) and the Joanna Briggs Methods for Case study reporting guide followed. Thematic analysis with a feminist lens was applied to the data. ResultsThree themes were generated ‘Through the looking glass; observing ethical issues’; ‘Whose body Is It? The Erosion of Maternal Consent’ and ‘Relational care versus defensive practice’. These themes explain the antecedents and consequences of the ethical issues identified by the midwifery student, the findings are supported by ethical theory and midwifery philosophy to highlight some of the underlying causes that contribute to ethical issues. ConclusionMidwifery students experience ethical distress when they observe ethical issues and are powerless to support birth people in a way that aligns with midwifery philosophy of relational, woman-centred care. Further research is required to better understand how midwifery students may be better supported to foster ethical care.

7984 A Challenging Case Of Hyperphosphatemic Familial Tumoral Calcinosis

Abstract Disclosure: T.G. de Souza: None. T.J. Weber: None. Introduction: Hyperphosphatemic Familial Tumoral Calcinosis (hFTC) is a rare, autosomal recessive metabolic disorder characterized by elevated serum phosphate levels and the accumulation of calcium phosphate deposits in soft tissues. There are fewer that 150 genetically confirmed cases in the literature. There are no consensus guidelines; therapeutic approaches are guided by case reports or series. This case serves to heighten awareness of therapeutic strategies including global health considerations for the disabled adult with a rare bone disorder. Case: A 32-year-old African-American woman presented to establish care for hFTC, for which she takes ibuprofen for disabling bilateral hip pain. hFTC was diagnosed in early childhood and managed at a large children’s hospital. Therapeutic modalities relied on operative resection of skin lesions on eruption. She describes cosanguinous parentage, consignment to foster care as a child and homelessness as an adult. She has not had adult endocrine care for her hFTC. Her medical comorbidities include major depressive disorder, PTSD and suicide attempt. She reports one uncle with hFTC noting that his phenotype was not significantly disabling and apparent recession of his lesions with age. Her parents did not have symptoms of hFTC. Radiographically, she had amorphous calcium deposits over both hips (her primary sites of severe pain), upper back (site of painless spontaneous eruptions), and left elbow without pain or skin penetration, as well as hyperostosis of the ilium bilaterally. She noticed waxing and waning of her eruptions with her menstrual cycle, such that lesions worsen in the luteal phase. Megestrol acetate also induced new eruptions. Examination shows brown staining to all teeth with several missing teeth. She had a marked lower extremity limb length discrepancy with severe restriction of hip abduction. Blood chemistries were grossly normal, including renal function, calcium, uric acid and PTH. Serum phosphorous was elevated at 5.2 (2.3 - 4.5 mg/dL). CT showed bilateral nephrocalcinosis. We instituted treatment with a low phosphorous diet, sevelamer to reduce intestinal phosphate absorption and acetazolamide to increase urinary phosphate excretion. For her pain and functional disability, we recommended continued NSAIDs, physical therapy and social work consultation to facilitate continued access to care. Conclusions: This case uniquely describes hFTC symptom fluctuation with the menstrual cycle, worsening with increased progesterone, suggesting a possible role of gonadal hormones on FGF-23 biology. It also highlights the socioeconomic burdens that can accompany rare bone disease, which become more pronounced as the patient achieves adulthood. Successful transition of care from pediatric to adult endocrinologist, in addition to engaging multi-disciplinary support, is essential in optimizing life-long care in hFTC. Presentation: 6/1/2024

Raised by White People. Conceptualisations of ‘Culture’ in the Foster Placement of African Minority Youth in Norway

AbstractThis paper examines the intricate dynamics of transethnic foster placement in Norway, focusing on African minority youth and how ‘culture’ and ‘identity’ is conceptualised within this context. Through semi-structured interviews, the study builds on the lived experiences of a set of 15 families (including 60 children), alongside insights from fostered individuals, foster parents, and a placement official. The discussion delves into the profound effects of cultural dislocation and identity crisis experienced by minority youth, problematising how foster placement often leads to adverse life trajectories, including issues with uprootedness, substance abuse, psychiatric illness, and loss of ethnic identity. At the core of the discussion is the contention that while the child protection system in Norway is mandated to safeguard children, it inadvertently neglects the cultural rights and identity development of African minority youth. Employing insight from Franz Fanon and Jean-Paul Sartre to articulate the psychological impact and moral implications of such transethnic placements, the paper argues for re-evaluating assimilation practices and cultural rights within the child protection framework, highlighting the need for a culturally sensitive and rights-based approach to foster care. This research contributes to the broader discourse on human rights and social work, emphasising the ethical and legal dimensions of fostering minority children.

Preservice training perspectives among Florida foster parents

Relatively little is known about foster parent preservice training, particularly how foster parents perceive the helpfulness of preservice training. Given the high turnover of foster parents and research indicating that multiple demands are placed on foster parents, more attention should be paid to the preparation and support of new foster parents. The purpose of this study was to utilize an administrative data set from the state of Florida to examine foster parents’ perceptions of the type and quality of their preservice training in terms of feeling prepared to take on a foster care placement in their home. Almost one half of all participants were able to identify the name of the training completed. Of which, three of the trainings have some empirical support in published literature. Additionally, a little more than one half of participants indicated they felt prepared for their role as a foster parent, but almost one third indicated not feeling prepared for the role. Slightly more than one quarter of participants indicated supplementing their training with other resources. Results support the need for more rigorous evaluation of preservice training due to limited empirical support, attention to how training prepares foster parents to support the needs of the child and family following placement, and potential improvements to what is covered in preservice training.

Academic achievement among youth in foster care

This disproportionate rate of academic achievement among youth in foster care raises significant concerns given the social and economic benefits that earning a high school diploma provides over the course of an individual’s life. This study examines the relationship between a youth’s foster care experience (removal reason, number of placements, total number of days in foster care, connection to adult mentor, substance abuse, and dual-system involvement) and academic achievement across gender, race, ethnicity, and disabilities using the Adoption and Foster Care Analysis and Reporting (AFCARS) data and the National Youth in Transition Database (NYTD). This study found that several factors including gender, race, ethnicity, disability, connection to adult mentor, substance abuse referral, and dual-system involvement (incarceration) were associated with academic achievement. It is clear from the data that youth involved in the foster care system need increased support during their educational tenure. Low academic achievement rates among youth in foster care need to be addressed with more effectual, balanced, deliberate supportive resources, such as special education/disability services, mentoring programs, and independent living services (ILS) that connect youth in foster care to supports that will help them earn a high school diploma and increased the likelihood that they would go on to postsecondary education opportunity.

Disabled people as foster carers – closing the recruitment gap and more

Recent Ofsted statistics for fostering in England show a steady decline in the number of approved fostering households, whereas the number of children needing foster homes has increased. To address this disparity, the present study explored the views of Disabled and Non-disabled foster carers regarding inclusivity within the foster care recruitment system. A two-year project was led by the University of Worcester, in co-production with Shaping Our Lives and the Foster Care Co-operative, using mixed methods across four fostering agencies. Findings were that discriminatory practices, a lack of knowledge and flexibility in recruitment, and a lack of role models meant that Disabled people were generally not perceived as potential recruits. Examples of Disabled foster carers acting as effective foster carers were found, but these were very few and far between. Recommendations are that these discriminatory practices should be challenged at all levels and replaced with a culture of inclusion.

Intersectional disparities in access to mental health services among youth aging out of foster care

BackgroundYouth aging out of the child welfare system lack support in accessing needed mental health care, as do youth of color and LGBTQ ​+ ​youth in the general population. Similar disparities may exist among youth aging out of foster care who hold intersecting social identities. ObjectiveThis study aimed to explore the presence of mental health care access disparities among youth aging out of foster care using an intersectional lens. Participantsand Setting: The current study was a cross-sectional, exploratory analysis of secondary data from the Jim Casey Youth Opportunities Initiative (JCYOI) dataset. The sample included 2650 youth aging out of care. MethodsThe current study utilized bivariate tests to explore the association between access to mental health care and key variables, a rate ratio to measure access disparities, and logistic regression to determine the main effect of identity on mental health care access. FindingsLower rates of mental health care access were found among youth of color compared to White youth and among LGBTQ ​+ ​youth compared to non-LGBTQ ​+ ​youth. Disparities increased when youth of color also identified as LGBTQ+, however identity was not a significant predictor of mental health care access when controlling for insurance coverage and other variables. ConclusionsDisparities in access to needed mental health care found in the general population are also present among youth aging out of foster care. These findings suggest the need for targeted efforts from practitioners to ensure equitable access to mental health care for transition aged youth.

Minimum wages and foster care placement disruption

AbstractWe examine the potential secondary impacts of raising the minimum wage in a jurisdiction on the efficiency of its foster care placement system. We employ the Adoption and Foster Care Analysis and Reporting System (AFCARS) restricted‐access dataset representing all children in the US foster care system for the years 2000–21. We calculate placement efficiency as the number of yearly moves experienced by a child in the foster care system, with a decrease in the number of placements interpreted as benefitting children both psychologically and behaviourally. This increase in stability benefits the foster parents and corresponds to a smaller financial strain on the public. After including various controls and state‐year fixed effects, our Tobit and Ordinary Least Squares (OLS) analyses find that increased minimum wages are significantly associated with lower levels of placement disruption. We take this as promising initial descriptive evidence for the secondary effects of the minimum wage on reducing the financial burden, and increasing the placement efficiency, of the foster care system.

Child Welfare Practices and Foster Care: Relational Realities

‘Dark sides of kinship’ such as the abuse some kids are subject to by, or while in the care of, their biological parents remain prevalent in our day and age. However, society’s tolerance of these types of occurrences has greatly diminished. To assuage familial tragedies, formal state-run foster homes can alleviate the harmful effects caused by ‘negative kinships’ by offering safe havens to vulnerable children. This remedy is hardly a panacea though. By exploring three ethnographic examples and further readings from an anthropological lens, we argue that despite the protective essence foster homes entail in theory, much harm emerges from them in practice. The caretaking involved in foster care, although generally benevolent, promotes a semblance of normality that may equally mask darker aspects of the relational reality behind the precarious and sometimes deceptive ‘kin solidarity’ produced within these institutionalized settings. Furthermore, contemporary foster care in the West showcases how politics and kinship are entangled. This can be challenging throughout the fostering process, but especially when services - and, thus, associated relationships - are terminated. To increase the effectiveness of the protection granted to children who are severely affected by ‘negative kinships,’ including improving their potential prospects and well-being, we argue that it is critical that work be done to better identify and understand their embodied relational experiences.

Skills and knowledge therapists need to work with foster youth and families: According to key stakeholders in child welfare.

The current study relied on community-based participatory action research and qualitative methodology to explore the necessary skills and knowledge psychotherapists need to work effectively with foster youth and their families. In this study, the research team conducted interviews and focus groups with stakeholders (n = 48) in child welfare to learn how to support therapeutic relationships with foster youth clients. Using qualitative content analysis, the research team identified eight categories for needed knowledge and/or skills, such as collaboration with and inclusion of others in a client's system; flexibility and open-mindedness to individualize care follow the client's lead; and a solid understanding of trauma and attachment supported by therapist training and regular consultation specifically around foster care. These findings offer tangible suggestions for skills that psychotherapists can learn and practice in order to support beneficial mental health services for foster youth.

Keeping Siblings in Care Connected: Improving Relationship Stability via the Mockingbird Family Model

ABSTRACT Children and young people in Australian foster or kinship care are separated from their siblings for a range of reasons. These may include issues that are behavioural, sibling-related, the capacity of carers to host multiple children, or policies that enforce a one-child-per-bedroom rule. This study investigated strategies enhancing stability and meaningful connections among siblings within the Mockingbird Family, a social network model of foster and kinship caring. Case examples, network mapping, and visualisation of the Mockingbird Family networks are presented alongside results from thematic analysis of qualitative data. The findings suggest that the Mockingbird Family facilitates meaningful contact and sibling connections, even when coplacement was not possible. Sibling coplacement and contact provide crucial benefits such as emotional support, stability, shared experiences, and a sense of belonging, contributing to children’s and young people’s development, healing from trauma, and overall wellbeing. IMPLICATIONS Keeping sibling groups connected and in contact can reduce placement breakdown and contribute to their overall wellbeing. The Mockingbird Family model of foster care provides a range of options for keeping siblings meaningfully connected through coplacement within the same constellation and opportunities for other siblings to join in Mockingbird Family activities.

Foster care adoption recruitment methods: A review of the literature amid calls for reform in the United States

Over 113,000 children in the child welfare system have had their parent’s rights terminated in America. Family preservation and reunification should be priority goals for child welfare systems to prevent termination of parental rights and lessen the need for foster care adoptions. Systemic change is needed to preserve family bonds and lower the number of children aging out of foster care each year without family. Until that change occurs, foster care adoption is one of the options for permanency for children when returning to family is not possible. Millions of dollars are spent yearly on adoption recruitment strategies to find adoptive homes. There is little research on the outcomes of these models. This scoping review examines the state of the literature on foster care adoption recruitment efforts. The review found a small number of adoption recruitment studies (n = 15). More research should be implemented to better focus child welfare professionals’ effort, time, and funding on the most effective strategies to create permanent homes while also continuing to work on system reform to lessen the need for such adoptions in America.

The Interpersonal-Psychological theory of suicide in the context of (leaving) care: An empirical exploration of suicidal ideation among care-experienced young adults

People who lived in foster or residential care have a higher risk of suicidal ideation and behavior compared to those without care experience. However, most previous research has neglected applying suicide theories to help understand this risk. This paper presents findings from a cross-national study using the Interpersonal-Psychological Theory of Suicide (IPTS) to explore why care-experienced people, especially those leaving care, are more likely to have suicidal thoughts. The findings show associations between the IPTS factors, perceived burdensomeness and thwarted belongingness, and suicidal ideation among care-experienced young adults from England and Germany. This study contributes to helping develop necessary suicide prevention strategies across national care systems.

Magyarországi helyzetkép az alternatív gondoskodás lehetőségeiről, különös tekintettel a gyermekotthoni, nevelőszülői elhelyezésre

In this study, we compare institutional and foster care. The method chosen is a secondary analysis of statistical data. In the study, we seek to answer the question of how the number of places, the number of children, the age composition of children, the duration of placement and the type of placement vary in Hungary and in the Northern Great Plain region. We analyse data for the years 2014, 2021 and 2023 in terms of deinstitutionalisation and present the current situation of child protection care alongside the trends in institutional restructuring in recent years. A further aim of our comparative analysis is to review the number of cases of runaways from care in recent years, assuming that they occur less frequently in foster care. For the analysis, we have primarily used data for the years 2014, 2021 and 2023. In some places, the year 2020 was analysed due to data availability. We have used publicly available data series from the KSH, as well as data recorded on the basis of individual data requests according to the KSH OSAP Form 1208, which contains data provided by child protection centres based in the respective counties.

Primary and secondary trauma in adoptive parents.

Secondary trauma is recognised as one of the negative effects for professionals working with people that have experienced trauma. Research has demonstrated secondary trauma in foster carers but little research has explored trauma symptoms within adoptive parents, facing the emotional impact of parenting a child with adverse early experiences. This study aimed to document the rates of primary and secondary trauma symptoms in adoptive parents. It further explores the association between the extent of current behavioural and emotional challenges and the extent of the child's pre-adoption adverse experiences in predicting parental trauma responses. 190 adoptive parents completed an online survey including self-report measures of primary and secondary trauma. Almost one fifth of adoptive parents exhibited primary trauma scores of clinical concern; with 10% reaching the threshold for a probable diagnosis of PTSD. Participants also reported significantly higher levels of secondary trauma and burnout, and significantly lower levels of compassion satisfaction than population norms. The current behavioural and emotional challenges, including child-to-parent violence, predicted higher trauma scores more so than the extent of their child's past adverse experiences. The findings have clinical implications for identifying trauma symptoms within adoptive parents and wider implications for how we understand secondary and primary trauma. They further highlight the importance of firstly addressing current child behaviour, including child-to-parent violence when treating trauma symptoms. Limitations of this study and recommendations for further research are discussed.

The cognitive and language development of young Flemish foster children

Foster children often experienced adversities, putting them at risk for problematic outcomes ( Dozier & Rutter, 2016 ). To our knowledge, there is no research regarding the cognitive and language development of young Flemish foster children. In this study, we describe a study conducted longitudinal research over a one year period into the development of 53 young foster children (12–20 months old at T1). The cognitive and language development of the children was measured using the Bayley Scales of Infant and Toddler Development-Third-Edition (Bayley-III-NL). First, scaled scores of the Bayley subscales cognitive functioning, receptive language and expressive language, both at T1 and T2, were compared to the mean norm-scores. Second, the associated variables with the children’s functioning on cognitive and language scales were explored using Multilevel Modelling. For all subscales except receptive language at T2, the results did not significantly differ from the mean normative scores. The scores of the foster children in this study were significantly lower on receptive language at T2. When we looked at individual scores, most children (66%–83%) had scores that did not differ more than one standard deviation from the normative mean. Children in kinship foster care had lower scores in multiple developmental domains. There were also negative associations between both language subscales and insecure attachment behavior. For most subscales, the results did not significantly differ from the mean normative scores, which is promising.

To Belong: Narratives About Family Belonging Among Children in Foster Families or Where Custody has been Transferred

Abstract Background In 1983, 2001, 2002 and 2020 Swedish legislation has sought to strengthen children’s rights to family belonging in foster care, as well as their voices in decision making. The aim of this study was to understand how children in long-term foster families and children whose custody has been transferred experience family belonging within these different legal contexts. Methods: Six participants aged 11–17 years were recruited. The data were collected through narrative interviews. Both verbal and visual methods were used in data collection and narrative analysis was used to capture a comprehensive understanding of the stories. Findings: It is suggested that a sense of family belonging can be understood through the following themes: “To spend time”, “To share experiences”, “To be seen, cared for, and supported”, “To resemble someone”, and “To know or not to know”. Conclusion: Practical implications of the findings are discussed in relation to planning, guidance, and decision-making within foster care. The results, if implemented in practice, could have an impact on how to discuss foster children’s sense of family belonging within the foster care system.

Fixed fantasies of loss and reunion in a mother-baby treatment of intergenerational trauma

ABSTRACT Mother-baby pairs referred to the Anni Bergman Parent-Infant Outreach Program, in New York, are offered clinical services in urgent circumstances. Mothers are typically contending with crises stemming from poverty, loss, mental illness, and the various forms of social neglect, abuse, and racism built into New York City’s legal, educational, and foster-care systems. While dyadic interventions aim to develop parents’ attunement and reflective functioning towards their babies, the nature of the trauma these mothers have endured often shuts down the critical functions necessary for growth and change. In fact, aspects of their psychic life, in a unique survival mode, actively foreclose on new ways of relating; rather they remain tethered to early trauma with varied levels of representation. For example, the mother whom I write about in this paper, Janine, was transfixed by her own birth history in a way that preserved the force of her earliest pain and occluded the reality of her baby. A central therapeutic question is how to find a way into a mother’s closed system and build upon her healthy, loving wishes to care for her child. The therapist's capacity to enter these psychic voids and revive herself through reverie creates a path for intervention.