Youth In Foster Care Research Articles

Impact of COVID-19 on the educational experiences of youth in foster care: caseworker perspectives

ABSTRACT The coronavirus disease (COVID-19) pandemic significantly disrupted education systems in the United States as evidenced by school closures, the rapid implementation of online learning, physical distancing policies, and restrictions on extracurricular activities. Youth in foster care are a vulnerable population in need of school-based services and supports to ensure positive educational outcomes. This qualitative interview study assessed the pandemic’s impact on the educational experiences of foster youth from the perspectives of their caseworkers. Participant caseworkers discussed how the pandemic affected the academic progress and social/emotional development of youth in foster care and highlighted some challenges of online learning. They also described how the pandemic impacted classroom management, communication and relationships, and special education services. Overall, caseworkers believed many of the educational challenges caused by the pandemic would not have long-term implications, and they highlighted several positive outcomes resulting from the changes in school operations. Results suggest that caseworkers can mitigate some of the short-term negative effects by ensuring these students have reliable access to technology and that screenings and referrals for therapeutic services are completed in a timely manner.

Changing the Narrative. Refusing the Script

ABSTRACT Rarely do we hear a narrative written in the first person, written from the perspective of a child who grew up in the foster care system. This paper provides a window into the interior world of a child who experienced traumatic loss and abandonment. This child–born to emigrant Jamaican parents–grew up in the foster care system in the UK from the early 1970ʹs through the late 1980ʹs. This first-person account is written from the perspective of a child, but also from the perspective of a licensed social worker, a clinician with 26+ years of experience working with foster care youth and families. The writer is a graduate of The New School for Psychoanalytic Psychotherapy and Psychoanalysis, where he received training in Child and Adolescent Psychotherapy. This narrative is just one perspective of a personal journey, and in no way aims to speak for all children who grow up in the foster care system. Given some of the emotionally charged content in this paper, a few details are written in a deliberately vague way to protect the privacy of all persons involved.

The L.Y.G.H.T. Program: An Evaluation of a Peer Grief Support Intervention for Youth in Foster Care

The L.Y.G.H.T. Program: An Evaluation of a Peer Grief Support Intervention for Youth in Foster Care

Spotlight on Juvenile Justice: Intersecting the Child Welfare System

Crossover youth include youth who have experienced maltreatment and engage in delinquent behaviors.1 Dual-system youth – or crossover youth with prior or current involvement in both the child welfare and juvenile justice systems (45-70% of juvenile justice-involved youth)1 – represent a particularly vulnerable population. When compared with juvenile justice-involved youth without maltreatment or child welfare history, crossover and dual-system youth are disproportionately Black or Indigenous American, female, and/or sexually minoritized, and have higher mental health needs and service use.1 A study examining young adult outcomes in New York City found that nearly 15% of foster care youth and 57% of dually involved youth experienced incarceration within 6 years of leaving the child welfare system.2 In addition to poor outcomes associated with juvenile or criminal justice involvement, dually involved youth are at increased risk for poor adulthood outcomes related to education, employment, physical and mental health, homelessness, and further criminal justice involvement.2

Evaluation of a Health Navigator Pilot Program for Youth in Foster Care

The Health Navigator Program (HNP) was a pilot health mentor intervention program for youth in British Columbia, Canada, with connections to the provincial child welfare system. In this article, youth participants are referred to as “independent youth” as they are independent of traditional familial care. Children and youth in the foster care system face increased prevalence and risk of physical and mental health challenges with lasting implications throughout adulthood. The cumulative effect of childhood trauma, lack of connections to supportive adults, and structural obstacles such as poverty, racism, and sexism all contribute to creating significant barriers for independent youth navigating the health care system. The HNP was created to address these obstacles and facilitate improved health outcomes for independent youth. Youth from 2 program sites were paired with medical student volunteers who provided advocacy and mentorship. A qualitative process evaluation was undertaken to assess the effectiveness of the HNP in achieving the intended program outcomes. Findings revealed that the independent youth participants increased awareness of their own health needs, gained confidence in navigating the health care system, and had improved short-term health outcomes. Relationship building with a caring adult, outside of a paid professional role, was shown to be the most significant factor in achieving these positive outcomes.

Parent and Caregiver Relationships and Mental Health Symptom Profiles of Youth in Foster Care.

Adolescents in foster care can be quite resilient, yet they also are at risk for developing internalizing and externalizing mental health concerns. Positive family relationships are central to adolescent mental health, and these relationships can be complex for youth in foster care placements. Accordingly, there can be significant heterogeneity in the mental health symptoms of youth in foster care. The aims of this study were to identify distinct subgroups of youth patterns of internalizing and externalizing symptoms and determine the extent to which positive biological and foster parent relationships predicted profiles of low youth mental health symptoms. Using data from the National Survey of Child and Adolescent Well-being II (N = 343) and a person-centered analytic approach, results revealed four distinct profiles of youths' mental health symptoms, those with: high internalizing and high externalizing symptoms, high internalizing and moderate externalizing symptoms, moderate internalizing and moderate externalizing symptoms, and low internalizing and low externalizing symptoms. Additionally, youth with better relationships with biological parents were less likely to be in the high symptoms group compared to the low symptoms group. These findings can be used to inform targeted intervention efforts aimed to lessen the mental health symptoms of youth in foster care.

Patterns of healthcare utilization with placement changes for youth in foster care

BackgroundChildren in foster care experience poor health and high healthcare use. Child welfare agencies frequently require healthcare visits when children enter foster care; subsequent placement changes also disrupt healthcare. Studies of healthcare use have not accounted for placement changes. ObjectiveTo understand patterns of healthcare use throughout the time a child enters foster care and with placement changes, accounting for mandated visits when children enter foster care or experience a placement change. Participants and settingChildren 4 and older in foster care between 2012 and 2017 (N = 2787) with linked child welfare administrative data from one county child welfare agency and one Midwest pediatric healthcare system. MethodsNegative binomial models predicted healthcare days per month that were planned (e.g., scheduled primary/specialty care), unplanned (e.g., emergency care), or missed. ResultsPlanned healthcare days increased as a function of placement changes (Incident Rate Ratio [IRR] =1.69, p < .05) and decreased with placement stability (IRR = 0.92, p < .01). Mandated visits that occurred later in a placement were associated with fewer planned (IRR = 0.81, p < .01) and unplanned (IRR = 0.82, p < .01) healthcare days during that placement. ConclusionsPatterns of planned healthcare over the time children are in one placement and move between placements suggest more can be done to ensure youth remain connected to primary and specialty care throughout placements and placement transitions, s that children are seen as clinically appropriate rather than a function of placement disruption. Findings regarding the timing of mandated visits suggest that delays in mandated care may also reflect lower healthcare use overall.

COVID-19 Vaccination Perspectives Among Young Parents with Foster Care Backgrounds.

The COVID-19 pandemic has brought unique stressors for youth in foster care and recent foster care alumni, particularly those who are also parenting young children. One way the pandemic can be mitigated is through vaccination of the general population. Yet, some young adults have been slow to choose to be vaccinated. As has been demonstrated, simple availability of the COVID-19 vaccine will not guarantee its uptake, especially among marginalized populations. In order to better understand the nuances of vaccination among youth in foster care and recent foster care alumni, we conducted in-depth, semi-structured focus groups and interviews with 23 parenting youth with foster care histories aged 18-26 years. Data regarding vaccine attitudes were analyzed using thematic analysis. Participating youth, who were majority Black, Indigenous, and people of color (BIPOC) and often lived in multigenerational households, had significant concerns about the COVID-19 vaccine. They expressed varying degrees of intention to get vaccinated. Young people, especially those who belong to marginalized populations, need opportunities to openly discuss their vaccination-related questions without judgment. Science communicators should consider these questions and address youths’ concerns through diverse voices and channels to ensure youth have the information they need to make an informed decision regarding COVID-19 vaccination.

Understanding the Risk of Homelessness for Emerging Adult Foster Care Youth

This publication discusses foster care in the United States, risk of experiencing homelessness among foster care youth, and possible interventions. Written by Francesca Michelini, Randall Cantrell, and Kate Fogarty, and published by the UF/IFAS Department of Family, Youth and Community Sciences, January 2022.

Indigenous-centered racial disproportionality in American foster care: a national population study

ABSTRACT Exploration into disproportionate representation of marginalized populations in child welfare traditionally focuses on the ratio of child welfare involved youth rather than the disparities in needs, trajectories, and experiences while in foster care. Little is known about how American Indian and Alaskan Native children fare in foster care and no prior research using national data has used the individual as the unit of analysis. This study explores the experiences of Indigenous youth in foster care through their socio-demographic, physical and mental health, and foster care/placement factors. Differences in all domains were found between Indigenous and Non-Indigenous youth.

Antipsychotic medications and admission to psychiatric residential treatment facilities among youth in foster care diagnosed with disruptive behavior disorders.

Many youth in foster care are diagnosed with disruptive behavior disorder (DBD), a diagnosis indicative of aggression and behavior problems. These youth, who are at high risk for being placed in psychiatric residential treatment facilities (PRTF), are commonly prescribed antipsychotic (AP) medications off-label. However, treating children in the community is an important goal, and although AP medications can have severe side effects, these prescriptions may help to achieve this goal. In this study, we used Medicaid data to determine whether AP medications reduce the risk of admission to PRTF among two groups of children with DBD: those with DBD only and those who were diagnosed with DBD in addition to at least one of two conditions indicated for AP prescribing (psychosis and bipolar disorder.) Event history models show that AP medications are associated with a high rate of admission, which are likely due to the higher mental and behavioral health needs of youth who are prescribed. However, youth diagnosed with both DBD and indications who are prescribed an AP medication have one-tenth the rate of admission of similar youth who are not prescribed. For youth with DBD only, the findings are inconclusive. Given these mixed results, practitioners should follow clinical guidelines; ensuring youth are treated with psychosocial interventions and other psychotropic medications prior to AP prescribing. Agencies should attempt to address systemic factors such as shortages of foster homes, increased availability of therapeutic foster care, and implementation of in-home prevention services. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Exploration of Twin Separation and Adult Experiences: A Qualitative Study

Many researchers have studied the long-term impact of nontwin sibling separation in foster care, but little is known about the separation of twins. In this study, we examined how one specific set of adult fraternal twin sisters interpreted their personal experiences of separation from each other while in foster care and whether this experience affected their interpersonal relationships. The researchers relied on the theoretical foundations of attachment theory to support the use of existing literature and to integrate the research findings into current child welfare practice for human services professionals. Through personal interviews, each twin was asked to recall experiences from foster care and comment on the effects of being separated from their twin. Thematic analysis of the interview data and observations of the interview process helped to identify four themes: forming successful attachments, mental health issues, trauma history, and number and type of placements experienced. Implications for human services professionals working in social services agencies with youth in foster care are also discussed.

A Qualitative Descriptive of Best Practices Utilized by Foster Youth Support Program Staff at Community Colleges in California

The purpose of this qualitative descriptive study was to explore how foster care support program staff describe best practices to improve the financial, emotional, and academic experiences for foster care youth who matriculated into community colleges. For this study, the theoretical framework was ecological system by Urie Bronfenbrenner. This theory was used as a lens to understand how these support programs impacted foster youth students’ ability to stay in school to complete their degree and how support services impact their academic success by removing barriers financially, emotionally, and academically. The research questions that guided the study were: How do foster care support program staff describe best practices in financial interventions that support retention and success of foster care youth students who have matriculated into community colleges? How do foster care support program staff describe best practices in emotional interventions that support the retention and success of foster care youth students who have matriculated into community colleges? And, how do foster care support program staff describe best practices in academic interventions that support retention and success of foster care youth students who have matriculated into community colleges? The sample for this study was foster youth support staff who worked in California community colleges.

49.2 IMPACT OF THE LEADS (LEARN – EDUCATE – ACHIEVE – DREAM – SUCCEED) PROGRAM

Youth in foster care experience many factors that impede their educational progress and are subsequently less likely than their peers to graduate high school and attend college. In 2017, Georgia’s Multi-Agency Alliance for Children (MAAC) responded to this disparity through the development of a program called LEADS (Learn – Educate – Achieve – Dream – Succeed), which serves Metro Atlanta youth who are in ninth to 12th grade or pursuing their General Educational Development (GED). LEADS coordinates youth education assessments, creates individualized action plans, advocates for support to meet academic demands, and utilizes a trauma-informed, resiliency-based approach. The program has served over 400 youth and graduated over 80% of eligible seniors. In this presentation, child and adolescent psychiatrists will hear the findings from a 3-year evaluation of LEADS and direct program feedback from a youth presenter. The presenter will share findings from a 3-year, mixed-methods evaluation of LEADS including characteristics of the youth served, types of services provided, factors associated with success, and overall outcomes. Then a youth presenter who participated in LEADS will offer their perceptions of the program. Finally, the presenter will make suggestions for policy and practice changes among child-serving agencies and strategies for local officials. Participants will learn about individual and organizational factors that impact the educational progress of youth in foster care, practice ideas from the LEADS program model, and direct youth perspective, policy recommendations, and areas for future research. When youth in foster care are provided with individualized, coordinated, intensive services, and advocacy from caring individuals, they can succeed academically. Attendees will learn how LEADS serves each student and collaborates with other agencies to provide seamless support and ensure their opportunity to thrive in their transition to adulthood and productive citizenship.

Thought Problems and Aggression Over Time Among Youth in Foster Care.

BackgroundYouth in foster care may demonstrate high levels of aggression and thought problems. There is a growing trend to consider mental health symptoms of youth involved with the foster care system from a developmental trauma perspective.ObjectiveThe aim of this study was to test if trauma, race, age, and gender predicted variability in thought problems and aggression for youth in foster care.MethodThe sample (n = 303) included youth in out-of-home placements with a mean age of 14 years, a diverse racial demographic, and almost an equal percentage of males and females. Participants were assessed over three waves using a series of multilevel growth curve models.ResultsResults indicated significant decreases in thought problems and aggression and youth with higher levels of trauma reported higher initial levels and swifter decreases of both thought problems and aggression over time.ConclusionsWhile trauma was associated with aggression and thought problems, results found that youth demonstrated significant decreases in aggression and thought problems over time. A better understanding of the long-term effects of trauma on thought problems and aggression of youth in foster care is needed. While our findings suggest foster care may be protective in fostering resilience, additional research on the nature of potential positive effects of foster care on aggression and thought problems is suggested.

Linking Foster Family Characteristics and Mental Health Symptoms of Youth in Care.

Youth in foster care are disproportionately at risk for developing internalizing and externalizing problems (Lawrence et al., 2006); however, a history of maltreatment prior to foster care placement does not automatically result in poor mental health outcomes. Among non-foster care youth, the quality of family interactions has been related to adjustment outcomes, such that low family cohesion and high family conflict is associated with poor mental health symptoms (Caples & Barrera, 2006). While little is known about these constructs in foster care placements, they may help explain the variance in internalizing and externalizing problems for youth in foster care. The present study aimed to examine whether characteristics of the foster care environment (i.e., conflict, cohesion) across various placement types (i.e., traditional foster homes, group-care settings) could help explain the link between previous maltreatment exposure and mental health problems. The sample included 178 youth in foster care (Mage = 15.18, SD = 1.76) and their foster caregivers living in the Midwest. Youth participants completed self-report measures about prior maltreatment history, current family environment characteristics, and youth internalizing symptoms. Foster caregivers completed measures on current family environment and youth externalizing symptoms. Results indicated that caregiver report, but not youth report, of family cohesion was negatively associated with youth report of internalizing problems. When examining the indirect effects, youth report of family conflict partially accounted for the link between youth self-report of maltreatment and internalizing symptoms (B = 0.106, 95% CI = 0.026–0.186). Caregiver report of family conflict fully accounted for the association between youth self-report of maltreatment and caregiver report of youths’ externalizing symptoms (B = 0.108, 95% CI = 0.005–0.211). Findings highlight the importance of utilizing multiple informants when measuring foster family environment and suggest that family conflict is particularly salient for the mental health of youth in foster care.

Potential traumatic events and symptoms of post-traumatic stress in unaccompanied refugee minors—a comparison with youth in foster care

Building knowledge on how child welfare services (CWS) should tailor services for unaccompanied refugee minors (URMs) is important. URMs and youth in foster care are high-risk groups taken care of by the CWS in Norway. Little is known on whether knowledge gained from youth in foster care can inform services for URMs, and if these groups are comparable in terms of experiences of potential traumatic events (PTEs) and post-traumatic stress disorder (PTSD) symptom load. Eighty-one URMs reported PTEs and PTSD-symptoms using an adapted version of the Child and Adolescent Trauma Screen (CATS). Responses were described and compared with a sample of 303 youth in foster care in linear regression models. We present relative risks (RR) and standardized mean differences (SMD) for the PTEs and the PTSD subscale and total score between the groups in forest plots. URMs had experienced a mean (standard deviation) of 6.4 (3.4) PTEs and 43.9% reported to have PTSD-symptoms at or above the clinical cut off. Compared to the foster youth, URMs reported more exposures of interpersonal violence outside of the family (RRs ranging from 66.4 [95%CI 18.1; 243.5) to 1.3 (1.0, 1.5)], and more PTSD-symptoms in the re-experiencing subscale [SMD = 0.3 (95% CI 0.1, 0.6)]. The frequency and types of PTEs and the PTSD-symptom load and profile among URMs and youth in foster care differed. Findings underscore the importance of qualified and targeted care for URMs, and that this care should differ to that of other high-risk groups in the CWS.

Identifying gaps in training on sexual health for caregivers of adolescents in foster care

ABSTRACT Youth in foster care are a vulnerable group of adolescents that experience worse sexual health outcomes, including higher rates of STIs, HIV, and early and repeat pregnancy, compared to youth not in foster care. Caregivers of youth in foster care may play a critical role in improving the sexual health of youth in their care. However, many caregivers of youth in foster care do not talk to youth about sexual health, and few studies have directly asked caregivers about the trainings they may need to provide better sex education to youth. This exploratory study examined the training needs of caregivers of youth in foster care. Participants were a state-wide sample of 347 caregivers of youth in foster care in North Carolina, United States, who completed an online survey that asked about training needs. Almost half (49.0%) of participants state that they do not feel fully prepared to parent youth in foster care. Seventy-two percent of participants indicated they would like to receive more training on at least one of the three topics relevant to adolescent relationships and sexual health. By topic, the percentage of participants who desired more information included: peer pressure and friendships (48.1%); sexuality and sexual risk reduction (e.g. healthy relationships, pregnancy, STIs) (43.8%); and puberty and physical development (40.3%). Another area that most participants expressed a desire for more training was adolescent technology use (56.2%) – which is relevant to adolescent relationships and sexuality given a rise in the use of technology-based platforms to meet relationship partners, look at pornography, and share sexual messages and photos. Many caregivers desire additional training on how to engage with youth about sexuality and sexual risk reduction. Training caregivers of youth in foster care may be an effective strategy for improving the sexual health outcomes of this vulnerable population of youth.

Internalizing Symptom Profiles Among Youth in Foster Care: A Comparison Study

Background: A high prevalence of anxiety and depression is found among youth in foster care. There is limited knowledge on the anxiety and depression symptom profiles of youth in foster care. We examined latent profiles of anxiety and depression symptoms across three unique youth samples and whether youth in foster care were more or less likely to belong to specific symptom profiles than their peers recruited from clinical or general youth populations. We also investigated if these profiles were predicted by sex and age.Methods: Self-reported anxiety and depression symptoms were assessed by Spence Children's Anxiety Scale and Short Mood and Feelings Questionnaire. Data were pooled from three youth samples (N = 2,005; mean age = 13.9 years, range = 11–18 years) comprising youth in foster care (n = 245), a clinical youth sample (n = 107), and a general population youth sample (n = 1,653). Symptom profiles were identified using latent profile analyses. Multinominal logistic regression was used to predict the latent profile membership.Results: Three profiles that differed both in symptom level and shape were identified and labeled as low, medium, and high symptom profile. Compared to the general population youth sample, youth in foster care had a higher likelihood of belonging to the high symptom profile, but not the medium symptom profile. Youth from the clinical sample had an increased risk of belonging to the medium and high symptom profiles compared to the youth in foster care and general population youth samples. Across samples, girls yielded a higher likelihood of having a medium or high symptom profile. Increasing age was associated with a higher likelihood of being in the high symptom profile.Conclusion: Compared to their counterparts in the general population, youth in foster care are at risk of belonging to a class of youth with high symptom levels across subtypes of internalizing symptoms, indicating the importance of systematic and broad assessment of internalizing symptoms among these youth. Knowledge on the symptom profiles of anxiety subtypes and depression increases our understanding of the treatment needs of youth in foster care.

Process, practices, and outcomes of trauma-focused services in a statewide treatment foster care program

Many youth in treatment foster care (TFC) have been exposed to traumatic life events that are associated with negative health outcomes, yet few studies have examined how TFC programs are addressing the needs of trauma-exposed youth. This study used clinical data from 542 youth enrolled in TFC services within a statewide publicly funded mental health system from 2008 to 2018 to explore (a) how many youth receive trauma treatment, including youth diagnosed with PTSD, (b) to what extent common elements for youth trauma treatment are among the interventions employed during months when trauma was included as a treatment focus, and (c) clinician-reported trauma treatment progress. Only 34% of all youth in TFC, and 56% of youth diagnosed with PTSD, received treatment with any focus on trauma during the first six months of TFC. Therapists used a variety of therapeutic strategies during months when trauma was treated, some of which were consistent with the evidence-base for youth traumatic stress. Therapists reported 36% of youth with some trauma treatment focus made, at most, minimal improvement on trauma concerns during this time. Considerations for research and clinical practice in trauma-focused treatment foster care services are discussed.