Young Children In Foster Care Research Articles

Reducing Abuse and Neglect Recurrence Among Young Foster Children Reunified With Their Families.

Child maltreatment (CM) is a recurrent adverse life event known to cause enduring psychiatric impairment throughout life. For young children in protective custody for a first episode of CM, specialized court-coordinated intervention to optimize reunification has shown promise for preventing CM recidivism, with case series documenting short-term successes. We tracked 10-year (Nov 2011-March 2022) court re-entry outcomes in a cohort of 272 young children, birth to six years, reunited with their families following placement in protective custody and court referral to the SYNCHRONY Project, a voluntary clinical service providing Incredible YearsTM parenting education, parental psychiatric care, and serial dyadic clinical evaluation to inform medical recommendations on safety for visitation and reunification. Re-entry was operationalized as rereferral to any Missouri Court and proportions compared with contemporaneous State and national data. SYNCHRONY-enrolled/reunified children experienced frequencies of guardianship (22%) and reunification (46%), in keeping with Missouri averages. In these categories, 3.4% and 7.1% respectively were re-referred to the Court over the 10-year follow-up. In care as usual nationally for this age group, the re-referral proportions are 18% (OR 7.5, P < .0001) and 35% (OR 6.1, P < .0001) respectively. In care as usual in Missouri across all ages, the re-referral proportion is 16% (odds ratio [OR] 3.09, P < .0001). Judicious implementation of evidence-based parenting education, 2-generation psychiatric care, and clinical consultation were associated with marked reduction in court re-entry versus care-as-usual and warrant consideration in intervention standards for young children in foster care.

Using the talking album to elicit the views of young children in foster care regarding a reading intervention

There is wide ranging research that uses innovative methods to seek the views of children in out-of-home care. In the area of education, this group of children increasingly participate in research that involves various educational interventions (including book-gifting, tutoring, paired reading), that are designed to improve their educational attainment and achievements. Despite the overall growth in research evidence, there remains an absence of widely reported research on children’s views of the educational interventions that they are involved in and secondly, an absence of more reflective contributions that outline the methodological opportunities and challenges involved. This paper makes a contribution to both areas by reporting both the findings of and critical reflections on the use of an innovative method, the Talking Album, to gather the views of young children, aged 7–9 years old, regarding a reading intervention they were involved in, known as the Reading Together programme. The methodological approach is outlined. Informed by the basic principles underpinning children’s rights as set out in the UNCRC, key learning on the selection, introduction, and support of such methods/tools is reflected upon. From the findings and reflections, recommendations for future research that concerns interventions with children are made.

Caregiving quality modulates neuroendocrine and immunological markers in young children in foster care who have experienced early adversity.

Early adversity is believed to alter the body's stress-response systems, putting children at increased risk for somatic and mental health problems. However, it remains unclear whether such alterations normalize under improved caregiving experiences. Thus, the goal of the present study was to investigate (a) whether children in foster care show endocrine and immunological alterations relative to children living with their biological families, (b) whether these alterations change over time spent with the foster family, and (c) whether the alterations are modulated by current caregiving experiences. A total of 94 children in foster care and 157 biological children, aged two to seven years, took part in a longitudinal study with three assessments conducted over a 12-month study period. At the initial assessment, children lived for an average of 18 months with their current foster families. Children's cortisol, dehydroepiandrosterone (DHEA) and progesterone concentrations and cortisol/DHEA ratios were measured in scalp hair and children's secretory immunoglobulin A (sIgA) levels in saliva. Caregiving quality was assessed based on caregiver-reports and observational measures of caregiver-child interactions. Children in foster care had lower cortisol/DHEA ratios and higher progesterone concentrations than biological children, while no group differences were found for cortisol, DHEA or sIgA. Time spent with the current foster family did not significantly influence the child's endocrine or immunological markers. Importantly, caregiving quality modulated cortisol/DHEA ratios and sIgA concentrations: children in foster care of lower caregiving quality had lower cortisol/DHEA ratios than children in foster care of higher caregiving quality and showed decreasing, rather than increasing, sIgA concentrations across the study period. Our results indicate that caregiving quality in the foster family may have an important modulating effect on selected indicators of the child's stress response and could thereby mitigate the possible consequences of early childhood adversity.

How Anxious are German Preschool Children?

The experience of fear is universal and is among the earliest of all forms of psychopathology, if excessively present. To prevent negative developmental outcomes due to early-onset excessive fears in children, it is important to systematically assess these experiences as early as possible. Using the preschool anxiety scale (PAS), we aimed to assess the frequency and structure of anxiety symptoms of 489 preschool-aged children raised in their biological family and 88 raised in foster care (as a high-risk sample) in Germany. While these young children displayed the same types of anxiety most commonly as young children in other countries, the overall occurrence seems to be reported less often by parents in Germany compared to parents from other countries. Anxiety symptoms clustered into five correlated factors (generalized anxiety, social anxiety, obsessive–compulsive disorder (OCD), physical injury fear and separation anxiety). Young children in foster care exhibited more OCD and significantly less social anxiety symptoms indicating early repetitive and social disturbances in children in foster care.

In the face of a pandemic: adapting a mentalization-focused treatment that promotes attachment with birth parents and young children in foster care

ABSTRACT The central focus of the Building Blocks Program is to increase the mentalizing capacity of high-risk birth mothers whose young children under the age of five have been placed in foster care. In Building Blocks, therapists are trained to provide dyadic psychotherapy with a birth mother and her child during court-mandated supervised visits, with the aim of reducing cycles of trauma, abuse and neglect, and facilitating a more secure attachment. The program is psychoanalytically informed, grounded in theories of attachment, mentalization and reflective functioning. On March 14, 2020, due to the rapidly spreading coronavirus, it became clear that the birth parents could no longer safely visit with their children in person. In addition, court hearings that might have allowed the retention of parental rights were postponed, leaving many parents devastated. In this paper, we first describe how we adapted the Building Blocks approach during the pandemic. Second, two case examples are presented that highlight the pre-pandemic work of Building Blocks, as well as the innovative and creative ways the treatment model was adapted when it became unsafe to conduct dyadic therapy at the clinic. Using virtual video platforms, the Building Blocks Program has applied the model of ‘Nested Mentalization,’ providing support and scaffolding for the therapists, parents and children.

Developmental Status of Young Children in Foster Care.

Children in foster care (CFC) may be at higher risk for developmental problems. This study sought to determine (1) the percentage of CFC with developmental problems seen at an integrated primary care clinic and (2) whether the presence of various risk factors was associated with increased odds of developmental problems in general and across developmental domains. This cross-sectional study used the Ages and Stages Questionnaire, Third Edition, demographic, and health-related data retrieved from electronic health records. The study included 796 children aged 1 to 66 months seen at an integrated primary care clinic exclusively serving CFC. Frequencies and percentages of children with developmental problems were calculated, and relationships between developmental status and potential risk factors were accessed using χ2 and bivariate logistic regression analyses. Overall, 68.5% had scores indicative of developmental concern (DC), and 39.8% had scores indicating developmental delay (DD). After adjusting for other risk factors, analysis suggested that being male (odds ratio [OR] 2.169, 95% confidence interval [CI] 1.595-2.950) and exhibiting trauma symptoms (OR 1.51, 95% CI 0.993-2.295) were associated with higher odds of exhibiting DC, whereas being in a kinship placement (OR 0.55, 95% CI 0.359-0.842) was associated with lower odds. Odds were higher for exhibiting DD for children who were male (OR 1.716, 95% CI 1.278-2.303), born prematurely (OR 2.165, 95% CI 1.438-3.259), experienced physical abuse (OR 1.541, 95% CI 1.040-2.283), and presented trauma symptoms (OR 1.441, 95% CI 0.975-2.130). The findings suggest that early screening is vital for CFC to identify developmental impairment so that appropriate education and interventions can be offered.

Security-first thinking and educational practices for young children in foster care in Sweden and England: A think piece

• Little research exists about young fostered children and their education. • Fewer fostered children attend centre based early childhood education. • Attachment theory focus may have led to ‘security first’ thinking by foster carers • Foster carers are often carrying out educational practices in their homes. • A large scale study of foster carers’ educational roles and their impacts is needed. While the education of looked after children has attracted considerable policy attention in Europe and North America, and globally the early education of preschool aged children is the subject of substantial investment, the early education of young children in foster care is neglected in both research and policy. This paper is a cross-national think piece to stimulate research and debate about young children in foster care. We present findings from two studies, one in England and one in Sweden, exploring foster carers’ views and practices with young children. We argue that there is a perceived tension, in foster care policy and practice, between education and emotional wellbeing such that young children’s attachment relationships and sense of security is privileged over their engagement in educational practices. Attachment relationships are a necessary but insufficient condition for optimal development of fostered children.

Taking Care Triple P for Foster Parents With Young Children in Foster Care: Results of a 1-Year Randomized Trial

Young children with a history of maltreatment or neglect in foster families often confront their caregivers with particularly challenging behaviors. This may lead to more parenting stress, an increased risk for the child in foster care to experience further maltreatment, and placement disruptions. We conducted a randomized controlled trial to investigate the efficacy of a parent group training tailored to the special needs of foster families. We hypothesized significant short- and long-term improvements regarding foster parents' parenting competencies, child mental health problems, and related outcomes. Eighty-one families with 87 children in foster care aged 2 to 7 years participated in the trial. For the intervention study, 44 randomly selected families (54%) were offered to participate in the parent group training. Intervention and control group families were reassessed three times over a period of 1 year. Contrary to our expectations, we found no advantages of the intervention group compared with the usual care control group on any outcome measure. Instead, we found some significant changes in both groups across time. Placement into foster care is associated with some favorable outcomes for children in foster care. Additional support for foster families beyond the services delivered in the youth welfare system to foster parents was not associated with more favorable outcomes. The present intervention is likely associated with a low risk of harm but also with a high likelihood of a lack of significant benefits for foster parents and their young children going beyond feeling satisfied about the delivered services. Participating foster families showed favorable baseline results on parenting measures which may have impeded intervention effects to unfold on these proximal variables.

Complex ‘everyday’ lives meet multiple networks: the social and educational lives of young children in foster care and their foster carers

The everyday lives of young fostered children are rarely studied. Using an ethnographic approach including interviews, walks, observation and photomap making, this article reports on the findings f...

Enhancing the language development of toddlers in foster care by promoting foster parents' sensitivity: Results from a randomized controlled trial.

Young children in foster care are at increased risk for problematic language development, making early intervention a critical tool in enhancing these children's foundational language abilities. This study examined the efficacy of an early preventative intervention, Attachment and Biobehavioral Catch-up for Toddlers (ABC-T), in improving the receptive vocabulary abilities of toddlers placed in foster care. All the children had been removed from their biological parents' care and placed into foster care. When children were between 24 and 36months old, foster parents were contacted by research staff and consented to participate. Parents were randomly assigned using a random number generator to receive either ABC-T (n=45), which aimed to promote sensitive parenting for children who have experienced early adversity, or a control intervention (n=43). Foster children's receptive vocabulary skills were assessed post-intervention using the Peabody Picture Vocabulary Test, Third Edition, when children were between 36 and 60months old. Children whose foster parents received ABC-T demonstrated more advanced receptive vocabulary abilities than children whose foster parents received the control intervention. The positive effect of ABC-T on foster children's receptive vocabulary was mediated by increases in foster parents' sensitivity during parent-child interactions. Trial registration: ClinicalTrials.gov NCT01261806.

Reactive Attachment Disorder in maltreated young children in foster care

ABSTRACTReactive attachment disorder (RAD) is one of the least researched and most poorly understood psychiatric disorders. Very little is known about the prevalence and stability of RAD symptoms over time. Until recently it has been difficult to investigate RAD due to limited tools for informing a diagnosis. Utilising a newly developed observational tool along with the Disturbances of Attachment Interview. this short-term prospective longitudinal study explored RAD symptoms in maltreated young children in Scotland (n=100, age range =12–62 months) over 12 months. Children were recruited as part of The Best Services Trial (BeST?), in which all infants who came in to the care of the local authority in Glasgow due to child protection concerns were invited to participate. Prevalence of RAD was found to be 5.0% (n=5, 95% CI [0.7–9.3]) when children were first placed in to foster care. Following at least 1 year of improved care conditions, prevalence in the 76 children remaining in the study was 2.1% (n=2, 95% CI [below 0–4.7]). RAD was associated with some mental health and cognitive difficulties. While levels of carer-reported RAD symptoms decreased significantly over time, observed symptoms did not. Findings suggest that RAD resolved in a small majority of cases but further exploration in larger samples would be invaluable.

Cost effectiveness of a school readiness intervention for foster children

ObjectiveMany young children in foster care suffer from emotional and behavior problems due to neglect and abuse. These problems can lead to difficulties in school, and functioning in school is linked to long-term health and development. Early intervention to reduce emotional and behavioral issues can help children successfully transition to school, which can improve long-term outcomes. However, communities need information on relative costs and benefits associated with programs to make informed choices. The objective of this study was to assess cost effectiveness, over 12months, of the Kids in Transition to School (KITS) intervention compared to usual services available to children in a foster care control group (FCC). MethodRandomized controlled trial of 192 children in foster care entering kindergarten who were randomized to KITS (n=102) or FCC (n=90). KITS includes school readiness groups and parent training over 4months. Main outcomes were days free from internalizing symptoms (IFD), days free from externalizing behavior (EFD), intervention costs, public agency costs, and incremental cost effectiveness. ResultsKITS significantly increased IFD and EFD compared to FCC. Average total cost of the intervention was $932 per family. The intervention did not significantly impact usual services. Average incremental cost effectiveness was $64 per IFD and $63 per EFD. ConclusionsThe cost of KITS is comparable to, or less than, similar programs, and the intervention is likely to provide significant emotional and behavioral benefit and improvement in school readiness for young children in foster care.

Parental drug use and permanency for young children in foster care: A competing risks analysis of reunification, guardianship, and adoption

•Drug removals are a barrier to reunification and guardianship.•Children ages 0–3 with drug removals face a unique disadvantage for permanency.•Likelihood of permanency exits depends both on child age and drug removal status.

Enhancing executive functioning among toddlers in foster care with an attachment-based intervention.

Young children in foster care often experience adversity, such as maltreatment and lack of stability in early caregiving relationships. As a result, these children are at risk for a range of problems, including deficits in executive functioning. The Attachment and Biobehavioral Catch-up for Toddlers (ABC-T) intervention was designed to help foster parents behave in ways that promote the development of young children's emerging self-regulatory capabilities. Participants included 173 parent-toddler dyads in three groups: foster families that were randomly assigned to receive either the ABC-T intervention (n = 63) or a control intervention (n = 58), as well as low-risk parent-toddler dyads from intact families (n = 52). At a follow-up conducted when children were approximately 48 months old, children's executive functioning abilities were assessed with the attention problems scale of the Child Behavior Checklist (Achenbach & Rescorla, 2000) and a graded version of the Dimensional Change Card Sort developed for preschoolers (Beck, Schaefer, Pang, & Carlson, 2011). Results showed that foster children whose parents received the ABC-T intervention and low-risk children never placed in foster care had fewer parent-reported attention problems and demonstrated greater cognitive flexibility during the Dimensional Change Card Sort than foster children whose parents received the control intervention. These results indicate that an attachment-based intervention implemented among toddlers in foster care is effective in enhancing children's executive functioning capabilities.

Mental health needs and therapeutic service utilization of young children in foster care in Germany

Although children in foster care often need therapeutic help, the ways to initiate therapeutic services for them is not regulated in Germany. The objective of this cross-sectional study is to identify factors associated with therapeutic service utilization in young children in foster care in Germany. Additionally, it explores predictors of foster parents' perceived need for therapeutic help for the child. Foster parents of 286 children aged 3–7years completed questionnaires about children's mental health, child and placement characteristics. Logistic regression models tested the impact of these factors on therapeutic service utilization and foster parents' perceived need for child therapy separately for children with and without potentially traumatic experiences. Approximately 62% of the sample had some mental health problems; around 37% of these children received no treatment. Placement disruptions and cases where the child welfare services had the custodial rights predicted higher therapeutic service utilization. Foster parents' stress was associated with perceived need for help. Children's symptoms – especially externalizing problems – also predicted both outcomes. The findings indicate the need for strategies to increase therapeutic service utilization in young children in foster care on caregiver, system, and legislative levels. Such strategies should target routine assessment of children's mental health as well as interventions on foster family characteristics.

Psychotropic Medications in Very Young Children in Foster Care: Taking Leadership in Developing Best Practices Locally and Regionally

Psychotropic Medications in Very Young Children in Foster Care: Taking Leadership in Developing Best Practices Locally and Regionally

Translational Neuroscience as a Tool for Intervention Development in the Context of High-Adversity Families.

The use of theory-driven models to develop and evaluate family-based intervention programs has a long history in psychology. Some of the first evidence-based parenting programs to address child problem behavior, developed in the 1970s, were grounded in causal models derived from longitudinal developmental research. The same translational strategies can also be applied to designing programs that leverage emerging scientific knowledge about the effects of early adverse experiences on neurobiological systems to reduce risk and promote well-being. By specifying not only behavioral targets but also affected underlying neural systems, interventions can become more precise and efficient. This chapter describes the development of a program of research focusing on an intervention for young children in foster care. The intervention emerged from social learning theory research and employs a translational neuroscience approach. The conceptual model guiding the research, which incorporates behavioral domains as well as stress-regulatory neural systems, is described. Finally, future directions for translational neuroscience in family-based intervention research are considered.

Two-Generation Psychiatric Intervention in the Prevention of Early Childhood Maltreatment Recidivism.

OBJECTIVE: This article describes experience and early outcomes of a two-generation approach to preventive psychiatric care in the common setting of foster care, in which young children in particular are at extreme high-risk for child maltreatment and its long-term consequences. Currently there exist few reimbursable mechanisms by which to implement what has been shown to offset risk for maltreatment recidivism among families in the child welfare system. This represents a missed opportunity for the prevention of psychopathology in childhood. METHODS: The manuscript briefly reviews the current literature on child maltreatment as a preventable cause of psychopathology, discusses current best practices for its prevention in the setting of foster care, and describes the experience and early outcomes of a two-generation clinical psychiatric service, the SYNCHRONY Project, developed at Washington University and based on the Tulane model described by Zeanah et al. (2001). RESULTS: In comparison to an historic cohort of 247 young children in foster care in St. Louis County whose cases were closed prior to the launch of the SYNCHRONY Project, we observed among program participants significant reductions in time in foster care, despite the fact that the referred cases were at substantially higher risk than an average historic case. Serial standardized observations of the children and families in the program revealed improved adaptive functioning of the children, improvement in parenting practices of the parents as a function of evidence-based parenting education (provided as a component of intervention), and extremely low rates of maltreatment recidivism. CONCLUSION: Two-generation psychiatric care, including evidence-based parenting education, can be successfully implemented among infants and young children at extreme high risk, was associated with steady improvement in adaptive and relational functioning of parent-child dyads, and represents a promising intervention for the prevention of child maltreatment recidivism in public health practice. Language: en

An exploratory study of mental health interventions with infants and young children in foster care

ABSTRACTChild maltreatment negatively affects the well-being and development of youth in the United States. Infants and young children are disproportionately affected in number and severity by abuse and neglect, yielding short- and long-term developmental challenges requiring the identification of research-informed, trauma-focused early interventions. This exploratory study examines 23 children who started mental health treatment at, or before, age 5. All children were removed from home for reasons of suspected abuse and neglect, placed into foster care, and provided long-term, relationship-based psychotherapy for an average of 3.35 years through A Home Within, a national nonprofit focused on the emotional health of foster children. Findings indicate substantial reductions in therapist-reported symptoms of depression, anxiety, dissociative symptoms, self-injurious behavior, sleep problems, enuresis, school problems, conduct problems, sexualized behavior, and aggression. These preliminary results support the benefits of early intervention, focused on relationships, with maltreated infants, toddlers, and pre-school children and call for additional research on interventions designed for, and utilized with, foster children.

What Helps Children and Young People Move Forward Following Child Maltreatment?

What Helps Children and Young People Move Forward Following Child Maltreatment?