History Of Foster Care Placement Research Articles

The 4C model of healthy sleep for childhood interpersonal trauma

Restorative sleep is foundational for growth and development but remains a largely neglected area of health in the context of childhood trauma. This healthcare gap is especially great among child victims of interpersonal trauma who experience sleep disturbances at high rates. A trauma-informed framework is imperative both for understanding and addressing sleep-wake dysregulation in this vulnerable population. This article introduces the 4C Model of Healthy Sleep for Childhood Interpersonal Trauma as a resource and tool for professionals who provide services and support for these children in various settings (e.g., pediatricians, social workers, prevention specialists). Model components were developed and derived from evidence-based pediatric sleep practices, principles of attachment theory, reciprocal relationships between trauma and sleep disruption, and sleep intervention research among children with a history of foster care placement. Developed for use with infants and children up to 10 years of age, the trauma-informed model aims to educate and empower caregivers with behavioral tools for reducing sleep-related problems among child victims of interpersonal trauma including attachment disruptions. Although not intended to address complex sleep problems and disorders, the relevance and conciseness of the 4C model provides a needed resource for both research and practice.

“They're scared that somebody's gonna judge them”: Female African American youth in foster care's perspectives on sexual and reproductive health communication with caregivers

BackgroundObtaining accurate information is critical for youth's sexual and reproductive health (SRH). Youth not in foster care often learn about SRH from their biological parents. Separated from their biological parents, youth in care depend on healthcare providers and caregivers for SRH information. However, they often receive insufficient information and feel unsupported in meeting their needs for SRH information. PurposeThis study explored female African American adolescents in foster care's perspectives on effective SRH communication with caregivers to help them avoid sexual risks. MethodsA qualitative study was conducted using semi-structured interviews. We used purposive sampling to recruit 16 adolescents aged 18 to 20 years old with a history of foster care placement. The transcribed interviews underwent inductive thematic analysis. The Positive Youth Development theory underpinned this research. ResultsTwo prominent themes emerged: establishing a relationship and preferred communication approach. Youth reported that for caregivers to engage in effective SRH communication, they must first establish a relationship by being aware of the youth's childhood trauma, building trust, having patience, and being vulnerable. Youth also appreciated caregivers who ensured comfortability and were honest and straightforward. DiscussionCaregivers should be trained on adverse childhood experiences, trauma-informed approaches, SRH knowledge, and communication. Implications to practiceHealthcare providers should make use of the time spent with youth and discuss SRH topics during clinical encounters. This time spent with youth may be their only chance to obtain accurate SRH information. Youth's perspectives regarding communication about SRH should be implemented in future SRH communication interventions.

3.70 Foster Care and Vitamin D in Females Admitted to a Psychiatric Residential Treatment Facility

3.70 Foster Care and Vitamin D in Females Admitted to a Psychiatric Residential Treatment Facility

Predictors of service utilization among homeless former foster youth: Implications for intervention

Summary A high percentage of homeless youth have a history of foster care placement; this population faces high rates of behavioral health problems. No research has focused on the predictors of service use among homeless former foster youth. This analysis seeks to determine what foster care and homeless experiences are associated with service use among this population. Data were collected via convenience sample from 184 homeless former foster youth at a drop-in center in Hollywood, California. A series of logistic regressions were conducted for network engagement behaviors that may be impacted by foster care experiences. Knowledge from prior empirical results form the basis for this analysis. Findings Number of foster care placements and age at first foster care placement, overall time spent homeless, age at first homelessness, and being kicked out of housing as a cause of homelessness were associated with decreased service use. Time spent in foster care and homeless experiences during foster care were associated with increased service use. Application Results can be used to aid in understanding which foster care and homeless experiences aid or hinder service use. From a policy level, findings from this study can aid child welfare agencies in further understanding which foster care experiences present as risk factors after transition from care.

Experiences during COVID-19: Needs of college students with a history of foster care

The effects of the coronavirus disease 2019 (COVID-19) have been nothing short of profound, with disparate impact among historically marginalized and under-resourced populations. Eighty undergraduate college students, with a history of foster care placement, describe their experiences during Shelter in Place due to COVID-19. Former and current foster youth already experience challenges in accessing and completing higher education; these challenges were exacerbated by the measures taken to deal with risks associated with the pandemic. Study findings build upon previous studies that indicated that former and current foster youth have unique and significant pandemic related financial, physical and psychosocial concerns, by using conventional content analysis methods to describe what participants identified as needed resources. Findings have implications for future research and policy development, as well as resource provision during ongoing remote learning, and in preparation for the eventual transition back to in-person instruction.

Multiple Types of Childhood Maltreatment, Sleep, and Anxiety in Former Foster Youth

Although existing literature has widely identified significant relationships between a history of childhood maltreatment and mental health problems and between a history of childhood maltreatment and sleep problems, less is known about relationships between experiences of multiple types of childhood maltreatment, sleep problems, and anxiety in low-income young adults and former foster youth. This study aimed to explore whether experiences of multiple types of childhood maltreatment, a history of foster care placement, lifetime trauma, and hours of sleep would be associated with anxiety in low-income young adults and former foster youth. The study surveyed a total sample of 143 young adults, and their hours of sleep were measured with FitBits. Multiple regression analyses were conducted to examine the relationships between experiences of multiple types of childhood maltreatment, a history of foster care placement, lifetime trauma, hours of sleep, and anxiety. The study found a significant relationship between multiple types of child maltreatment and anxiety, after controlling for a history of foster care placement, lifetime trauma, and demographic information. Notably, while experiences of multiple types of child maltreatment and a history of foster care placement were no longer associated with anxiety, a lifetime history of trauma remained associated with anxiety, after controlling for hours of sleep. Social workers and service providers need to provide low-income young adults and former foster youth with interventions aimed at addressing both sleep problems and traumatic stress, which may in turn reduce the risk for anxiety.

“I'm not Gonna Die Because of an STD”: Female African American Adolescents' Perspectives on how they Protected Themselves from Sexual Risks While in Foster Care

PurposeYouth in foster care are at greater risk for engaging in sexual behaviors that increase their odds of experiencing negative sexual and reproductive health (SRH) outcomes. The purpose of this qualitative study was to describe challenges faced by female African American adolescents in foster care as they tried to protect themselves from SRH risks and protective beliefs and behaviors to avoid these risks. Design and methodsSemi-structured interviews were conducted with 16 female African American adolescents, ages 18–20 years, with a history of foster care placement during adolescence. Purposive sampling was done to recruit participants from a metropolitan area in Virginia. Transcribed interviews underwent inductive thematic analysis. This paper focuses on the theme of protection from SRH risks and its subthemes of challenges that made it difficult to avoid sexual risks and protective beliefs and behaviors that facilitated avoidance of those risks. ResultsParticipants reported yearning for connection, partners' desire to not use condoms, and judgmental caregivers as challenges. Protective beliefs and behaviors included open communication with their caregivers about SRH, abstinence, contraceptive use, and participants' desire to be healthy. ConclusionsStudy findings shed light on protective beliefs and behaviors female youth in foster care used to safeguard themselves from negative SRH outcomes. Youth at times lacked agency in sexual decision-making and contraceptive use. Practice implicationsFindings highlight the importance of sexual relationships and partner communication related to contraceptive use, and offering trauma-informed interventions, including culturally sensitive counseling regarding long acting reversible contraception.

“It was only me against the world.” Female African American Adolescents’ perspectives on their sexual and reproductive health learning and experiences while in foster care: Implications for positive youth development

Female African American adolescents experience high rates of sexually transmitted infections and unintended pregnancies. However, little is known about the sexual and reproductive health (SRH) needs of youth in foster care. This study explored the experiences of female African American/Black youth in foster care related to their SRH disparities and needs. The purposive sample was 16 female adolescents, ages 18–20 years old, with a history of foster care placement. Participants were recruited from a metropolitan area in Virginia. This study used a qualitative descriptive design with semi-structured in-depth interviews lasting an average of 1 h. The transcribed interviews underwent inductive thematic analysis, and four prominent themes emerged: caregiver barriers, facilitators, sources of information, and recommendations for caregivers. Results indicated that youth felt unsupported, relied on their strengths to seek information related to SRH, and provided their advice on communication about SRH with youth. The findings from this study will provide direction on how caregivers, health-care workers, social services staff, and community members can better support the SRH needs of young women in foster care.

History of foster care among homeless adults with mental illness in Vancouver, British Columbia: a precursor to trajectories of risk.

BackgroundIt is well documented that a disproportionate number of homeless adults have childhood histories of foster care placement(s). This study examines the relationship between foster care placement as a predictor of adult substance use disorders (including frequency, severity and type), mental illness, vocational functioning, service use and duration of homelessness among a sample of homeless adults with mental illness. We hypothesize that a history of foster care predicts earlier, more severe and more frequent substance use, multiple mental disorder diagnoses, discontinuous work history, and longer durations of homelessness.MethodsThis study was conducted using baseline data from two randomized controlled trials in Vancouver, British Columbia for participants who responded to a series of questions pertaining to out-of-home care at 12 months follow-up (n = 442). Primary outcomes included current mental disorders; substance use including type, frequency and severity; physical health; duration of homelessness; vocational functioning; and service use.ResultsIn multivariable regression models, a history of foster care placement independently predicted incomplete high school, duration of homelessness, discontinuous work history, less severe types of mental illness, multiple mental disorders, early initiation of drug and/or alcohol use, and daily drug use.ConclusionsThis is the first Canadian study to investigate the relationship between a history of foster care and current substance use among homeless adults with mental illness, controlling for several other potential confounding factors. It is important to screen homeless youth who exit foster care for substance use, and to provide integrated treatment for concurrent disorders to homeless youth and adults who have both psychiatric and substance use problems.Trials registration numbersBoth trials are registered with the International Standard Randomized Control Trial Number Register and were assigned ISRCTN57595077 (Vancouver At Home Study: Housing First plus assertive community treatment versus congregate housing plus supports versus treatment as usual) and ISRCTN66721740 (Vancouver At Home Study: Housing First plus intensive case management versus treatment as usual) on September 9, 2012.

Long-term depression and suicidal ideation outcomes subsequent to emancipation from foster care: Pathways to psychiatric risk in the Métis population

Major depressive episode (MDE) and suicidal ideation (SI) associated with history of foster care placement (HxFCP), and mediating effects of psychosocial and socioeconomic factors through which placement may confer psychiatric risks in the years subsequent to emancipation were examined in a national sample of 7534 Métis. More than one third of emancipated respondents reported past year MDE, a prevalence rate nearly 50% higher than the rate of MDE among Métis respondents without a history of placement in foster care. The 25% lifetime prevalence rate of SI in the emancipated group was more than twice the rate observed in the non-fostered group. Direct effects of HxFCP on post placement MDE and SI were significant in multivariate logistic regression analyses, even when effects of childhood predispositional risk factors were controlled statistically. Emancipated individuals were unduly affected by psychosocial and socioeconomic disadvantages signifying pathways that linked foster care placement history and psychiatric status. Main mediators of the effects demonstrated using effect decomposition procedures were self-esteem, income, and community adversity. The findings warrant consideration of foster care history in clarifying the complex etiologies of suicidal ideation and major depressive episode in the Métis population and risk factors ensuing in the intervening years as integral to the process linking placement to long-term psychiatric outcomes.

Career Mentoring Needs of Youths in Foster Care: Voices for Change

Adolescents with a history of foster care placement are more likely to become homeless, have mental illness, become parents too early in life, or become incarcerated within the juvenile justice/prison system. In addition, a low percentage of young adults, who formerly were in foster care, complete vocational training or higher education. This was a qualitative study, using focus group methodology. Four focus group sessions were conducted with youth living in foster care. The purpose was to obtain their perceptions about mentoring. Focus groups comprised six to eight youths per group and were guided by a semi-structured interview guide. A total of 27 youth in foster care participated in focus group interviews. Mean age was 16.4 (SD = 0.68) years. Youth participants were very knowledgeable about mentoring programs for at-risk youth, along with negative psychosocial outcomes experienced by former foster youth. However, they remarked that they are given few opportunities for career mentoring. The overall themes that emerged from narrative data were needing and finding authority figures, hooking up with a career mentor, and deserving the good life. Career mentoring is an affordable and feasible intervention for child welfare agencies. This could lead to more motivated and prepared youth living in foster care for vocational training or higher education. Learning opportunities from a career mentor may be a lifeline for preventing negative psychosocial outcomes for foster youth, reward achievement goals, and improve overall quality of life in emerging adulthood.

Comparisons of substance abuse, high-risk sexual behavior and depressive symptoms among homeless youth with and without a history of foster care placement

Aims and objectives: The purpose of this study was to compare prevalence of substance use, high-risk sexual behaviors, and depression symptoms between homeless youth with and without a history of foster care placement. Background: Approximately 26,000 young persons exit foster care annually in the United States. Once they ‘age out’ of foster care, however, many young persons do not have access to comprehensive health care. They also are at risk for substance abuse, homelessness, or mental illness. Because persons with a history of foster care are at risk for negative psycho-social outcomes, it is unclear if these young people might be different than homeless youth without this history. Design: The design is descriptive and cross-sectional. Methods: A total of 156 homeless young persons, of whom 44 had a history of foster care placement, were recruited from a drop-in center that caters to homeless youth and young adults. Results: The sample was majority male and white; ages were 16–25. Significantly higher proportion of homeless former foster youth used methamphetamine within the last six months compared to non-fostered homeless youth p = 0.03). Homeless former foster youth were significantly older (p = 0.02) and less educated (p = 0.02) than their homeless counterparts without a history of foster care placement. Prevalence of using tobacco, marijuana, alcohol, crack cocaine, and powder cocaine were similar for both groups. Although not significant, a higher proportion of homeless former foster youth reported trading sex for money or drugs compared to non-fostered, homeless youth (19% versus 12% [trading sex for money], and 26% versus 14% [trading sex for drugs], respectively. Conclusions: Findings from this study show that, in general, homelessness is a negative outcome, irrespective of having a foster care history. However, those with that history need continued support when transitioning to independent living, such as access to health care, and encouragement to further their education. Relevance to clinical practice: It is important that nurses, who serve homeless youth populations, conduct a risk assessment profile, in order to ascertain a history of foster care placement, link former foster youth to social service agencies that provide risk reduction/health promotion education, and advocate for stable housing.

Comparisons of Substance Abuse, High-risk Sexual Behavior and Depressive Symptoms among Homeless Youth with and Without a History of Foster Care Placement

Comparisons of Substance Abuse, High-risk Sexual Behavior and Depressive Symptoms among Homeless Youth with and Without a History of Foster Care Placement

The impact of mental health issues, substance use, and exposure to victimization on pregnancy rates among a sample of youth with past-year foster care placement

The purpose of this study is to (1) compare youth entering substance abuse treatment with and without a history of foster care placement to determine any differences in mental health, substance use, and exposure to victimization, and (2) determine if mental health, substance use, and/or exposure to victimization predict past pregnancy among the sample with a history of foster care placement. The pooled dataset consisted of 17,124 adolescents (12–17 years of age) who completed the Global Appraisal of Individual Needs at intake for substance abuse treatment in 2009. Of these, 366 (2.1%) reported having been in foster care in the past year. When compared with a non-foster care sample, the foster care sample reported significantly higher internal mental distress scores, behavior complexity scores, and general victimization scores, after controlling for race, gender, and level of care. Problems associated with substance use did not differ between groups, though regular tobacco use was present at a higher rate in the foster care sample. Multivariate logistic regression results revealed that, within the foster care sample, internal mental distress and gender predicted past pregnancy. There may be room for intervention within substance abuse treatment centers for youth with a history of foster care, who may be at risk for pregnancy if their levels of internal mental distress are high.

Foster Care Placement, Poor Parenting, and Negative Outcomes Among Homeless Young Adults

Although homeless youth with and without foster care histories both face adverse life circumstances, little is known about how these two groups compare in terms of their early histories and whether they face similar outcomes. As such, we compared those with and without a history of foster care placement to determine if the associations between a history of poor parenting and negative outcomes including depression, delinquency, physical and sexual victimization, and substance use, are similar for these two groups. The sample consisted of 172 homeless young adults from the Midwestern United States. Multivariate results revealed that among those previously in foster care, a history of physical abuse and neglect were positively associated with more depressive symptoms whereas sexual abuse and neglect were related to delinquency and physical victimization. Additionally, lower caretaker monitoring was linked to greater delinquent participation. Among those without a history of foster care, physical abuse was related to more depressive symptoms whereas sexual abuse was positively correlated with delinquency, sexual victimization, and substance use. Furthermore, lower monitoring was related to more substance use. Our findings are discussed in terms of a social stress framework and we review the implications of foster care placement for homeless young adults.

Is inhalant use a risk factor for heroin and injection drug use among adolescents in the United States?

Purpose We examined whether inhalant use was associated with heroin and injection drug use (IDU) among adolescents aged 12 to 17 in the United States. Methods Data were drawn from the 2002/2003 administrations of the National Survey on Drug Use and Health (NSDUH). We conducted logistic regression analyses to estimate associations of inhalant use with heroin use, heroin injection, and IDU, respectively, among adolescent drug users ( N = 8161). Results Approximately 30.9% of adolescents had ever used at least one illicit drug. More than one-fifth (22.2%) of adolescents were past-year or recent drug users. Among past-year adolescent drug users, 1.4% had progressed to heroin use and 1.2% reported IDU. Adolescents who had used inhalants and marijuana were 2.8 and 2.9 times as likely as adolescents who had used marijuana but not inhalants to report heroin use and any IDU, respectively. Adolescents who had used inhalants or other drugs but not marijuana were unlikely to use heroin. However, inhalant users, irrespective of their marijuana use histories, had greater odds of IDU than drug users who had not used inhalants. Adolescent drug users who were females, school dropouts, whites, or delinquents had significantly increased odds of heroin use and IDU. Cigarette smoking before the age of 15 was strongly associated with heroin use, and a history of foster care placement was associated with IDU. Conclusions This national study of American adolescents identifies several subgroups of recent drug users, such as females, school dropouts, and youth who have used inhalants and marijuana, which have substantially increased odds of heroin use and IDU. Screening, prevention, and treatment interventions targeted to these groups might reduce medical and social complications of heroin use and IDU.

Psychiatric symptoms and substance use disorders in a nationally representative sample of American adolescents involved with foster care

Purpose To ascertain the prevalence of psychiatric symptoms and substance use disorders among adolescents with a lifetime history of foster care placement, using data from a nationally representative sample of U.S. adolescents. Methods We studied adolescents aged 12–17 years in the public use file of the 2000 National Household on Drug Abuse (n = 19,430, including 464 adolescents with history of foster care placement). Psychiatric symptoms and substance use disorders were ascertained through direct interviewing of adolescents. Logistic regression analyses were used to estimate the odds of past-year psychiatric symptoms and substance use disorders among adolescents involved with foster care, as compared to those without a lifetime history of foster care placement (comparison group). Results Adolescents involved with foster care had more past-year psychiatric symptoms, and especially more conduct symptoms, and past-year substance use disorders than those never placed in foster care. Adolescents involved with foster care were about four times more likely to have attempted suicide in the preceding 12 months (adjusted odds ratio [AOR] 3.95; 95% confidence interval [CI] 2.78, 5.61), and about five times more likely to receive a drug dependence diagnosis in the same period (AOR 4.81; 95% CI 3.22, 7.18). Conclusions Adolescents involved with foster care have a higher prevalence of psychiatric symptoms and drug use disorders than those never placed in foster care. Additionally, the results of this study suggest that they may be at elevated risk for suicide attempts.

Use of Mental Health Services by Youth in Contact with Social Services

This article compares mental health service need and use among three groups of children: those with a history of foster care placement, those in contact with departments of social services but never in placement, and those from impoverished families who have not been in contact with social services. Data come from a longitudinal epidemiologic study of mental health problems and service use. All three groups show very high rates of mental health problems, but children in foster care or in contact with social services are significantly more likely than children living in poverty to receive mental health services.