Foster Home Placement Research Articles

The association between adverse childhood experiences and insomnia symptoms from adolescence to adulthood: Evidence from the Add Health study

ObjectivesAdverse childhood experiences are potentially traumatic events that occur up to age 17, including abuse, neglect, and household dysfunction. Such trauma often results in chronic stress and poor sleep health, which are linked to negative health outcomes across the lifespan. This study examines the longitudinal association between adverse childhood experiences (ACEs) and insomnia symptoms from adolescence to adulthood. MethodsData from the National Longitudinal Study of Adolescent to Adult Health were used to examine the association between ACEs and insomnia symptoms (trouble falling asleep or staying asleep, dichotomized based on self-reported frequency of 3 times per week or more). We used weighted logistic regression to examine the association between cumulative ACE score (0, 1, 2-3, 4+), 10 specific ACEs, and insomnia symptoms. ResultsOf 12,039 participants, 75.3% experienced at least one adverse childhood experience and 14.7% experienced 4 or more. We found specific adverse childhood experiences, including physical abuse, emotional abuse, neglect, parental incarceration, parental alcoholism, foster home placement, and community violence were associated with experiencing insomnia symptoms throughout the entire 22-year follow-up period from adolescence to mid-adulthood (p < .05), while childhood poverty was only associated with insomnia symptoms in mid-adulthood. The number of adverse childhood experiences showed a dose-response association with insomnia symptoms in adolescence (1 adverse childhood experience: adjusted odds ratio (aOR)=1.47 [1.16, 1.87], 4+ adverse childhood experiences: aOR= 2.76, [2.18, 3.50]), early adulthood (1 adverse childhood experience: aOR= 1.43 [1.16, 1.75], 4+ adverse childhood experiences: aOR= 3.07 [2.47, 3.83]) and mid-adulthood (1 adverse childhood experience: aOR= 1.13 [0.94, 1.37], 4+ adverse childhood experiences: aOR= 1.89 [confidence interval: 1.53, 2.32]). ConclusionsAdverse childhood experiences are associated with an increased risk for insomnia symptoms across the lifespan.

The association between adverse childhood experiences and depression trajectories in the Add Health study

BackgroundAdverse childhood experiences (ACEs) are potentially traumatic experiences that occur before age 18. ACEs are linked to depression in adulthood, but little is known about the association between ACEs and depression trajectories across the lifespan. ObjectiveTo examine the association between specific types of ACEs, cumulative ACE scores, and depression trajectories from adolescence to adulthood. Participants and settingWaves 1–4 of the National Longitudinal Study of Adolescent to Adult Health (N = 12,888), spanning ages 12 years to 43 years. MethodsWe constructed trajectories of depression scores using a modified 9-item Center for Epidemiologic Studies Depression Scale (CES-D-9). We used weighted logistic regression to calculate odds ratios and confidence intervals for each ACE and ACE score and depression trajectories after adjusting for confounders. ResultsWe found 75.3 % experienced at least one ACE and 14.7 % experienced 4+ ACEs. We identified three CES-D-9 trajectories: consistently low (Group 1), decreasing (Group 2), and increasing (Group 3) depression scores. All types of abuse, neglect, and community violence were significantly associated with trajectory Groups 2 and 3 vs 1 (p < .05). Foster home placement, poverty, and parental incarceration were associated with Group 2 vs 1. ACE scores showed a dose-response association with Group 3 vs 1 [aORs for 1ACE = 1.43 (0.93–2.20); 2-3ACEs = 1.97 (1.30–3.00); 4+ACEs = 3.08 (1.86–5.09)], and Group 2 vs 1 [aORs for 1ACE = 1.26 (0.87–1.83); 2-3ACEs = 1.93 (1.36–2.74); 4+ACES = 2.70 (1.90–3.84)]. ConclusionsACEs can have a lasting impact on depression through adulthood, highlighting the need to mitigate their impact to prevent depression-associated morbidity and mortality.

Are children and adolescents in foster care at greater risk of mental health problems than their counterparts? A meta-analysis

This meta-analysis aims at comparing mental health problems of children in foster care to those living with their biological parents while taking in consideration different protective and risk factors. Across 41 studies with a total of 72 independent effect sizes, a significant but small effect size was found between foster care placement and psychopathology (d = 0.19). Children in foster care showed higher levels of psychopathology compared to those from community samples or matched/at-risk samples. They were as likely to show mental health problems as maltreated children living with their biological parents or children from clinical samples. Results showed that foster children’s mental health problems also varied as a function of type of placement and study methodological characteristics. Being placed in kinship care, longer stay in the same foster home and fewer placement disruptions, all acted as protective factors limiting mental health problems of children in foster care.

331 Adverse Childhood Experience and Sleep Quality in Adulthood

Abstract Introduction Poor sleep quality, a risk factor for many negative health outcomes, may result from physical or emotional disturbance including chronic stress. Adverse childhood experiences (ACEs) have been linked with chronic stress, and may therefore be associated with poor sleep quality in adulthood. This study examines the longitudinal association between specific ACEs and the number of ACEs and sleep quality in adulthood. Methods Using data from the National Longitudinal Study of Adolescent to Adult Health, we examined the association between ACEs and trouble falling asleep or staying asleep (rarely or never, sometimes, frequently) in waves 1 (age 12–18), 4 (age 24–32), and 5 (age 33–43). We examined ten ACEs (physical, sexual, or emotional abuse; neglect; parental death, incarceration, alcoholism, divorce or separation; foster home placement; poverty; and exposure to community violence) and the number of ACEs (0, 1, 2–3, 4+), using weighted logistic regression to calculate odds ratios and confidence intervals for each of the ACEs and ACE score and each of the outcomes after adjusting for relevant confounders. Results The analysis included 12,768 participants, 75.3% of whom experienced at least one ACE, including 14.7% who experienced 4 or more. Physical and emotional abuse were associated with frequent sleep complaints at waves 1, 4, and 5. Sexual abuse, neglect and community violence were associated with frequent complaints in two waves, while parental alcoholism, parental incarceration, and foster home placement were associated with frequent complaints in one wave. The number of ACEs experienced showed a dose-response association with frequent sleep complaints in wave 1 ([1 ACE: aOR=2.12 (1.16, 3.9), 2–3 ACEs: aOR=2.86 (1.70, 4.82), 4+ ACEs: aOR=4.17 (2.33, 7.48)], wave 4 [1 ACE: aOR=1.02 (0.77, 1.36); 2–3 ACEs: aOR= 1.66 (1.30, 2.10); 4+ ACEs: aOR=2.68 (1.99, 3.61) and in wave 5 [1 ACE: aOR=1.22 (0.93, 1.60)), 2–3 ACEs: aOR=1.42 (1.11, 1.81), 4+ ACEs: aOR=1.88 (1.40, 2.53)] Conclusion Certain adverse childhood experiences such as physical, sexual, and emotional abuse and neglect have a lasting impact on sleep quality in adulthood, highlighting the need to mitigate their impact to prevent negative health outcomes associated with poor sleep quality Support (if any):

The impact of out-of-home placement characteristics with regard to suicidal risk among adult survivors of childhood abuse

Background: Childhood abuse is associated with increased lifetime suicidal risk (SR). Among victims of abuse, children in out-of-home care are also at risk. Out-of-home placement is aimed at stopping further exposure to maltreatment and at providing the necessary security for proper development. Research suggests that placement arrangements may impact children’s mental health outcomes. Objective: The study was aimed at examining (1) the direct effects of different placement characteristics (i.e. age at first placement, number of placements, placement disruptions, total time in care, contact with biological parents, contact with siblings, placement with siblings) on SR and (2) whether these characteristics moderate the link between maltreatment and SR. Participants: The sample consisted of 77 adults (52 women; 25 men; mean age: 26.6 years) who received out-of-home care during childhood. Method: Participants completed the Childhood Trauma Questionnaire and the Mini International Neuropsychiatric Interview (for SR). Participants’ records were used to determine placement characteristics and maltreatment. Results: PLS-PM analyses suggest a significant role of risk (age at first placement, number of placements, placement disruptions, contact with biological parents) and protective factors (contact with siblings, foster home placement) on SR. Risk factors also moderate the link between maltreatment and SR. Conclusions: Interventions aimed at limiting risk factors during placement seem important to reduce SR.

Treatment Bed Utilization Following Placement in a Foster Care Program for Veterans with Serious Mental Illness

Hospital and residential treatment bed utilization rates were measured before and after foster home placement in individuals with serious mental illness. Medical records of all Veterans consecutively enrolled in a Department of Veterans Affairs Community Residential Care (CRC) program during a 6year period (N = 140) were reviewed retrospectively. Treatment bed days were tabulated by bed type (psychiatric hospital, inpatient detoxification, medical hospital, physical rehabilitation, and psychosocial residential treatment) for each patient during symmetric pre- and post-placement time intervals. Pre- and post-placement bed days were compared using the paired-sample t test in a naturalistic one-group pretest-posttest analytic design. Psychiatric hospital and residential treatment bed days were significantly reduced post-placement (-77.5% and -99.8%, respectively). Most patients (89.0%) had fewer psychiatric hospital bed days post-placement, and all patients with pre-placement residential treatment program bed days had fewer of those days post-placement. Longer CRC placements were associated with greater reductions in bed utilization.

The role of intergenerational context in recovery from complex trauma: It's all about attachment

Nicole is wheeled into the emergency room, flanked by four police officers and struggling mightily against the restraints that strap her to the gurney. One officer peels off to explain the situation: Nicole was brought in from her residential mental health treatment program after she became dysregulated with no apparent provocation, striking a male staff member in the face multiple times and attempting to elope. As Nicole settles in the ER, her mood rapidly shifts from angry and frustrated to sad and worried. During her physical examination, the ER staff notices multiple lacerations in various stages of healing scattered around Nicole's body. Nicole points to a specific laceration, noting that this was from her most recent suicide attempt. A few hours after being brought into the ER, Nicole is much calmer, with an almost vacant look in her eyes as she describes her early childhood to the psychiatry team. Without much feeling to her words, she recounts a history of being sexually abused from age 3–6 years old by one of her mother's boyfriends. Nicole describes the despair she felt because of her mother not believing her disclosures or protecting her, and the carousel of foster home, group home, and residential program placements after the Child Protective Services agency in her state removed her from the abusive situation she was living in.

Foster Placement Disruptions in France: Effects on Children and Adolescents’ Emotional Regulation

This study focuses on the continuity and disruptions of foster placements in France. Its aim is to understand the effects on emotional regulation (coping strategies and temperament) of fostered children and adolescents. Participants were 221 French children aged 7 to 16. Three types of French placement history were examined (single placements, multiple placements, and mixed parental and foster home placements). Children with no experience of maltreatment provided a normative reference. A quantitative method was used, including a coping strategy scale and a temperament questionnaire. Results indicate that children in the multiple placement group were more emotionally vulnerable than those in the other groups. Findings suggest that particular attention should be paid to ensuring stability in placements. A number of recommendations are made to promote stability, including coordination of child welfare and family support agencies, and training and support of foster families.

Association of adverse childhood experiences and neurodevelopmental disorders in people with fetal alcohol spectrum disorders (FASD) and non-FASD controls

BackgroundFetal alcohol spectrum disorder (FASD) is a highly prevalent lifelong disorder with high rates of comorbid neurodevelopmental disorders. Individuals with FASD are often exposed to abuse, neglect and foster home placements which have uncertain effects on the lifelong course of FASD. In this study we compare the prevalence of adverse childhood events (ACEs) and neurodevelopmental disorders in subjects with fetal alcohol spectrum disorders (FASD) and non-FASD controls.MethodsA cross-sectional chart review of patients referred to a regional developmental center was used to identify people with FASD and non-FASD controls. We recorded the number of ACEs and neurodevelopmental disorders in each patient’s chart. The most common diagnoses were attention deficit hyperactivity disorder, comprehension deficits, sleep disorders, and cognitive impairments. T-tests and a regression equation were utilized to determine significant differences between the groups.ResultsThe review identified 203 subjects, 98 with FASD and 105 non-FASD controls. Group mean age was 8.6 years and 64.5% were male. People with FASD were more likely to have any ACEs (mean 5.3) with ACE scores 3.7 points higher than non-FASD controls (mean 1.69) (t = 11.29; p < .001). Increased ACEs were associated with increased rates of neurodevelopmental disorders for people with FASD (R = .179, p = .026) but not for non-FASD controls (R = .130, p = .094).Conclusions: Both FASD and subsequent exposure to ACEs are associated with increased risk for development of comorbid neurodevelopmental disorders. Prevention of ACEs during childhood may decrease risk for development of comorbid neurodevelopmental disorders.

Mental health in youth prenatally exposed to opioids and poly-drugs and raised in permanent foster/adoptive homes: A prospective longitudinal study

BackgroundLittle is known about the mental health of prenatally opioid- and polydrug-exposed youth raised in foster/adoptive families. AimTo compare mental health problems among two groups of youth, one prenatally drug-exposed group with participants who were mainly placed in permanent foster or adoptive homes in early infancy and a group without known prenatal risk factors who were raised by their birth parents. MethodsThe sample consisted of 45 drug-exposed and 48 nonexposed youth between 17 and 22 years old from an original sample of 136 followed since birth. An extended version of the Mini International Neuropsychiatric Interview was used to assess lifetime psychiatric disorder, and participants completed the Achenbach Adult Self-Report form and Cantril's Ladder of Life Satisfaction Scale. ResultsA higher proportion of the youth in the drug-exposed group had lifetime experiences with major depressive episodes, alcohol abuse and attention deficit, hyperactivity disorder (OR > 3, p ≤ .030). They scored higher on the aggressive behavior scale, had more sexual partners and were younger at their sexual debut (p ≤ .030). There were no group differences in current self-reported satisfaction with life. ConclusionYouth exposed to drugs prenatally continue to represent a risk group despite early placement in permanent foster and adoptive homes. The factors contributing to this elevated risk may be multifaceted and involve adverse prenatal conditions including but not limited to drug exposure, genetics, and postnatal environmental conditions. The results highlight the need for longitudinal follow-up in the transition to adulthood as well as qualified service provision for these youth and their families.

Foster homes for neglected children with severe obesity-Debated but rarely studied.

To explore current research and theoretical articles on foster home placement of children with severe obesity. An integrative literature review. Literature searches in six electronic databases included theoretical, quantitative and qualitative articles and case reports published in English (2008-2018) on the topic of severe childhood obesity and foster home placement. Seventeen selected papers included six theoretical articles, nine quantitative studies, one qualitative study and one case report. Eight of the nine quantitative studies did not specify the grading of obesity in children in foster care. The case report and the qualitative study showed distinct and sustainable body mass index (BMI) reductions after a child had been placed in foster care. Five theoretical articles justified foster care placement when chronic parental neglect led to severe obesity in the child, while one article emphasised the opposite. Parental and societal neglect of children with severe obesity placed in a foster home is rarely studied or the exclusive aim of research. The views of the children themselves are lacking in research articles, as well as the child's right to health obligations concerning children with severe obesity.

Neglected children with severe obesity have a right to health: Is foster home an alternative?-A qualitative study.

To explore key person's perspectives of foster home placement or notification of risk of harm to Social Services of children with severe obesity. This case study research was performed in the southwest of Sweden and based on interviews with nine informants: a foster home youth, two foster parents, a social worker, two hospital social workers, a pediatric physician, a pediatric nurse, and a psychologist. Content analysis was used for narrative evaluations, within- and cross case analyses and displays. Positive health outcomes of the foster home placement were described as a healthy and normalized weight status, a physically and socially active life, and an optimistic outlook on the future. The foster parents made no major changes in their family routines, but applied an authoritative parenting style regarding limit setting about sweets and food portions and supporting physical activity. The professionals described children with severe obesity as having suffered parental as well as societal neglect. Their biological parents lacked the ability to undertake necessary lifestyle changes. Neglected investigations into learning disabilities and neuropsychiatric disorders were seen in the school and healthcare sector, and better collaboration with the Social Services after a report of harm might be a potential for future improvements. Rival discourses were underlying the (in) decision regarding foster home placement. A child's right to health was a strong discourse for acting when a child was at risk for harm, but parental rights are strong when relocation to a foster home is judged to be necessary.

Implementation of Trauma Systems Therapy-Foster Care in child welfare

Trauma exposure is pervasive among children living in foster care, and yet most resource parents (foster parents and kinship caregivers), child welfare staff, and others in the child welfare system are not adequately prepared to recognize and respond effectively when children exhibit trauma symptoms. Trauma-systems Therapy-Foster Care (TST-FC) is a systemwide model of trauma-informed care focused on meeting the emotional needs of children in foster care who have experienced traumatic events. This study evaluated the implementation of TST-FC in two state child welfare agencies that included training for staff (n = 123) and resource parents (n = 111). Study findings show training participants had positive perceptions of TST-FC and found it useful. TST-FC also was associated with significant increases in trauma-informed parenting and tolerance of children's misbehavior by resource parents, as well as more trauma-informed policies and practices in the child welfare agencies. Training participants reported that TST-FC provided useful tools and a common language about trauma that enhanced their capacity to collaborate with one another and manage children's difficult behavior. An exploratory study of resource home retention and children's placement stability revealed fewer foster home closures and placement disruptions when resource parents were trained in TST-FC compared to homes not trained in the model. The results of this study suggest that TST-FC is a promising model for increasing the capacity of child welfare agencies to provide trauma-informed care to children and families in the foster care system.

Creating valuable indigenous learning environments

ABSTRACTIndigenous governments are growing in size and strength. As a result, indigenous issues are becoming more frequently and prominently in the public administration landscape. Whether it is natural resource management, culturally appropriate foster home placements, or eradicating known drug trafficking routes that cross tribal jurisdictions, there are a multitude of ways that federal, state, and local public managers may encounter indigenous issues. Incorporating indigenous learning environments into public administration programs will not only serve to further the needs of indigenous students, but will also strengthen public administration programs as a whole. Our method for creating a learning environment that embraces indigenous students is to incorporate indigenous issues into the core curriculum, include indigenous ways of knowing into the program, provide for indigenous focused student assessment, and ensure cultural appropriateness. This four-pronged approach will ensure that an indigenous valued learning environment is part of any public administration program.

A Triage Tool to Assess Unmet Health Needs for Children Entering Foster Care

Children in foster care have high levels of health care needs, many of which are unmet at foster care entry. Health care coordination (HCC) is essential to ensure unmet needs are addressed rapidly. Data is lacking about how best to triage children at foster care entry so limited HCC resources can be allocated most effectively. Therefore, we aimed to: (1) utilize a Triage Tool (TT) at foster care entry to stratify children based on unmet health care needs and (2) determine if the TT is an accurate predictor of health care utilization as indicated by cost during a child’s first few weeks in care. A TT was developed and utilized during the initial foster care health exam (IFCHE) to stratify children based on unmet needs. Medicaid records were reviewed to determine health care utilization and cost during the first 60 days post-IFCHE. Most children (61.6%) had the lowest level of unmet needs (Level 3), 29.5% had a moderate level of unmet needs (Level 2), and 9.9% had the highest level of unmet needs (Level 1). Medicaid claims review revealed that triage level did not correlate to health care utilization or costs during the first 60 days post-IFCHE. Youth placed in a group home incurred significantly higher costs than those placed in foster homes. These results suggest that the TT is useful clinically but does not predict health care utilization and costs during the first weeks in care. Group home placement incurs more cost than foster home placement, independent of triage level assigned.

Lower anterior cingulate volume in seriously violent men with antisocial personality disorder or schizophrenia and a history of childhood abuse

Antisocial personality disorder (ASPD) and schizophrenia, as well as childhood abuse, are associated with violent behaviour and show marked volumetric reduction in the anterior cingulate (AC), a brain region implicated in regulation of violence through its involvement in decision making, empathy, impulse control, and emotion regulation. The present study examined, for the first time to the authors' knowledge, the grey matter volume of the AC in relation to seriously violent behaviour and childhood psychosocial deprivation (including physical and sexual abuse) in the context of a mental disorder (schizophrenia or ASPD). Fifty-seven men [14 with ASPD and a history of serious violence; 13 with schizophrenia and a history of serious violence (VSZ); 15 with schizophrenia without a violence history (SZ); 15 nonviolent healthy participants] underwent whole-brain magnetic resonance imaging and were rated on the presence of physical abuse, sexual abuse, neglect, extreme poverty, foster home placement, criminal parent, severe family conflict, and broken home (collectively 'psychosocial deprivation'). Stereological volumetric ratings of the AC were examined for group differences and their association with childhood psychosocial deprivation. A higher proportion of ASPD and VSZ patients had suffered psychosocial deprivation as children, in particular severe physical abuse, relative to SZ patients and healthy participants. ASPD and VSZ, but not SZ, patients had significantly lower AC volume relative to healthy participants. AC volumes correlated negatively with (total) psychosocial deprivation as well as physical and sexual abuse ratings. Group differences in AC volume became nonsignificant when psychosocial deprivation ratings were covaried for. Violent mentally disordered individuals with ASPD or schizophrenia suffer from a significant AC volume loss and this deficit, at least in part, is explained by their histories of stressful childhood experiences. Current and future therapies aiming to reduce violence in such populations would benefit by attending to biological (and other) correlates of childhood abuse.

A qualitative evaluation of a new community living model: medical foster home placement.

The Department of Veterans Affairs (VA) Medical Foster Home (MFH) program is an alternative to nursing home (NH) placement for veterans who are NH-eligible but prefer to receive care in private homes. Program expansion is ongoing; however, inefficiencies exist in targeting Veterans for enrollment. Semi-structured interviews were conducted with 35 individuals, 9 national MFH coordinators, 14 Primary Care Team Members, 2 veterans living in MFHs, 4 of their family members, 3 caregivers, and 3 family members of veterans who declined to participate in the program. Transcripts were analyzed using a general inductive approach supported by Archive for Technology, Lifeworld and Everyday language, text interpretation (ATLAS ti) V6.2. Three themes were identified as key facilitators of successful MFH placement: 1) The Environment - veterans needed to have appropriate and comfortable physical space that ensured safety and was in a desirable geographic location; 2) The Match - a collaborative relationship between veterans, care providers, and the medical team providing care within the home was essential; and 3) Perceptions and Expectations about the ability for needs to be met in MFHs and challenges related to health concerns, relocation, and costs. These themes, when integrated into the Social Ecological Model, provide a theoretical framework from which to guide future research and understand policy implications. MFHs represent a novel alternative to NH placement. This evaluation provides an understanding of factors that lead to successful MFH placement and integrates these themes into a theoretical framework designed to assist both VA policymakers interested in expanding the program and those within the civilian community seeking to study alternatives to traditional NH care.

Playing with Fire by Bruce Hale (review)

Reviewed by: Playing with Fire by Bruce Hale Elizabeth Bush Hale, Bruce . Playing with Fire; illus. by Brandon Dorman. Disney Hyperion, 2013. [320p]. (School for S.P.I.E.S.) ISBN 978-1-4231-6850-8 $15.99 R Gr. 5-8. None of Max Segredo's foster-home placements have worked out (hey, he wasn't the one who started those fires), and now he has reached the Merry Sunshine Orphanage, the penultimate stop before juvie hall. Immediately, there are pretty clear tip-offs that this isn't your average orphan school: a classmate attacks Max in his bed, and a faculty member slings a knife at him when he opens a random door. Merry Sunshine is, in fact, a training academy for juvenile spies, and the group is currently strategizing to stop a shipment of Nullthium-Ninety, a potent substance scheduled to be stolen and transported by LOTUS, an organization of really, really bad people. Unfortunately, Max is distracted by coded notes from an anonymous source suggesting that his father is still alive, and running his own side mission is more important to him than cooperating with a bunch of oddballs he barely knows. Max isn't the lead character for nothing, however, and after stowing away in barrels, evading infrared motion sensors, surviving a shark tank, and booby-trapping a villain's kitchen with an overcooked midnight snack, Max the near traitor turns into Max the hero, who realizes his fellow orphans are now his excellent new family. This is a short step up in complexity from Hale's Chet Gecko mysteries (The Chameleon Wore Chartreuse, BCCB 6/00), and fans of that series will appreciate that the author's signature similes ("His scrawls resembled football plays drawn by an orangutan with arthritis") transfer intact. A glorious spy career, a return visit from his problematic father, and several sequels are undoubtedly in Max Segredo's future. Copyright © 2013 The Board of Trustees of the University of Illinois

Remembering the "Forgotten Child": The American Indian Child Welfare Crisis of the 1960s and 1970s

Remembering the "Forgotten Child":The American Indian Child Welfare Crisis of the 1960s and 1970s Margaret D. Jacobs (bio) On Christmas Day 1975, Marcia Marie Summers was born to Charlene Summers, a member and resident of the Standing Rock Sioux Nation in North Dakota. A few months later, a white couple from Indiana approached the young mother and offered to care for her infant while Summers attended school. (Just two months before, the couple had filed an adoption petition in the Standing Rock Tribal Court for another Indian child, but the court had denied their request.) Assuming she was making a temporary arrangement, Summers agreed and signed a document giving the Indiana couple power of attorney over Marcia Marie in parent-child-related actions. Immediately, the couple departed with the baby from the reservation and returned to Indiana. Summers realized that the couple intended to permanently adopt her daughter, so she asked the Standing Rock Tribal Court to intervene. When the couple ignored the tribal court's order to return the child to her mother, Summers and tribal authorities requested the help of the Association on American Indian Affairs (AAIA). Their attorney filed a writ of habeas corpus on Summers's behalf in the Washington County, Indiana, Circuit Court, and the judge ordered Marcia Marie returned to her mother, noting the tribe's exclusive jurisdiction in the case.1 Like Summers, in the 1960s and 1970s, thousands of other American Indian parents, grandparents, and caretakers suffered the removal of their children and their placement in non-Indian foster or adoptive homes. Unlike Summers, however, many Indian families struggled for years to regain their children, and some were never able to effect their return. By the late 1960s, many Indian tribes had become deeply troubled by this practice. In 1968, having endured an inordinate number of [End Page 136] such cases, the Devils Lake (now Spirit Lake) Sioux Tribe of North Dakota requested that the AAIA conduct an investigation into the practice. The AAIA found that of 1,100 Devils Lake Sioux Indians under twenty-one years of age living on the Fort Totten reservation, 275, or 25 percent, had been separated from their families.2 Suspecting that this practice devastated other Indian communities as well, the AAIA engaged in a painstaking process to amass similar data from state social services agencies and private placement agencies across the nation. They discovered that in most states with large American Indian populations, 25 to 35 percent of Indian children had been separated from their families and placed in foster or adoptive homes or in institutions at a per capita rate far higher than that of non-Indian children.3 How did it come to pass that the fostering and adoption of Indian children outside their families and communities had reached these crisis proportions by the late 1960s? State welfare authorities and Bureau of Indian Affairs (BIA) officials alleged a dramatic rise in unmarried Indian mothers with unwanted children and claimed that many Indian individuals and families lacked the resources and skills to properly care for their own children. Claiming to be concerned with the best interests of the Indian child, the BIA promoted the increased fostering and adoption of Indian children in non-Indian families. Indian families and their advocates charged instead that many social workers were using ethnocentric and middle-class criteria to unnecessarily remove Indian children from their families and communities. Through creating their own child welfare organizations and legal codes, as well as working for the Indian Child Welfare Act (ICWA), Indian activists and their allies sought to bring Indian child welfare under the control of Indian nations. Given the shockingly high estimates of Indian children who were fostered or adopted outside their communities, surprisingly little historical research has been done on this topic. Most of the scholarship on Indian adoption has been in the fields of sociology, psychology, social work, and law. It has included outcomes studies and oral histories of adopted Indian children, debates about social work practice, and examinations of the new legal framework created by the passage of ICWA in 1978.4 Historians of American adoption have briefly mentioned Indian adoption, but they have generally subsumed...

The effect of different intervention programs on treatment adherence of HIV-infected children, a retrospective study

In HIV-infected children, long-term adherence to combination anti-retroviral therapy (cART) is difficult. In this retrospective study, we evaluated the effect of two different treatment adherence programs on treatment adherence (as indicated by cART failures) and the need for additional supportive care measures in a cohort of 31 HIV-infected children between 3 and 18 years of age. In a follow-up period of 6 years, we evaluated the treatment adherence at baseline (before introduction of any treatment adherence program in 2004) and compared this to cART failures during two treatment adherence programs (in respectively 2006 and 2009). The need for additional supportive care measures (the frequency of hospitalizations, daily observed treatment, use of child protection service, attendance of special schools, and placement in foster homes) was also evaluated at these three time points. The first treatment adherence program focused on increasing patient's obedience by imposing negative measures in case of treatment failure, whereas the second program aimed to increase treatment adherence by rewarding optimal medication intake. Prior to start of any treatment adherence intervention program, cART failures were observed in 29% of the pediatric patients. After introduction of the first treatment adherence program, cART failures decreased to 6%. During the second treatment adherence program, the cART failures remained equally low (10%), but the need for some specific additional supportive care measures (the frequency of hospitalizations and placement in foster homes) was importantly reduced. Treatment adherence programs are effective in increasing treatment adherence to cART in HIV-infected children. A novel reward treatment interventional program as an addition to social supportive care programs is a promising new positive enforcement program and can reduce the need for additional supportive care programs. Further prospective studies are needed to evaluate the long-term effect of this new treatment intervention program.