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PubMed1985

Foster care for child maltreatment: impact on delinquent behavior.

Previous reports of child maltreatment sequelae have not systematically examined the effects of societal intervention. A historical cohort study has been undertaken to examine the impact of one intervention, foster care, on the subsequent development of juvenile delinquency among child victims. One hundred fourteen foster children, aged 11 to 18 years, in foster care for three or more years, and who were in foster care as a result of maltreatment were studied. A comparison cohort was composed of 106 victims of maltreatment who were left in their family home; these children were similar to the children in foster care with regard to age, race, sex, and year of diagnosis. Cohort differences in maternal education, type of abuse, history of prior maltreatment, sex, and race were controlled in the analysis. Foster children committed 0.050 crimes per person-year after age 11 years; home care children committed 0.059 crimes per person-year after age 11 years (P greater than .2). Foster children were more likely to have committed criminal assault. Among foster children, increased number of foster home placements correlated with increased number of delinquency convictions. Overall, there appears to be no support for the idea that foster care is responsible for a significant portion of later problems encountered by victims of maltreatment.

Adolescent↗
PubMed1985

Foster care for child maltreatment. II. Impact on school performance.

At least 150,000 children currently reside in foster care in the United States because of child maltreatment. Nearly 15% of all confirmed maltreatment reports record foster care as one of the acute interventions. Yet, the impact of foster care has been largely unexamined. We conducted a historical cohort study of the impact of foster care on subsequent school performances for 114 children placed in foster care because of maltreatment. A comparison cohort was constituted of 106 maltreated children who were similar in age, race, sex, and year of diagnosis but who were left in their homes after report. School records were reviewed for 96 of the foster care children and 69 of the home care children. School attendance had improved for both groups at the time of follow-up nearly 8 years later. Children in school at the time of report who were then placed in foster care missed an average of 15.6% of the school year prior to the report compared with missing only 3.48% of the most recent school year. The children from the comparison group missed an average of 8.5% of the school year prior to their index maltreatment report and 7.2% of their most recent year in school. Forty-four percent of the foster care group achieved average or above average grades on follow-up compared with the passing rate for the home care group of 32% (P = .17). The foster care children were more likely to receive special education services. Overall, both groups were doing poor work in school an average of 8 years after maltreatment report. There appears to be no evidence for a significant rehabilitative effect of foster care as measured by subsequent school performance.

Absenteeism↗
PubMed2006

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.

Adolescent↗
PubMed2000

Factors influencing maltreated children's early adjustment in foster care.

Internal representations of self and primary attachment figures may be one mechanism by which maltreatment affects children's interpersonal behavior and relationships with others. Research on the continuity and influence of maltreated children's attachment representations, however, has not included youngsters removed from abusive or neglectful home environments. This paper examines the influence of maltreated children's maternal and self-representations on subsequent relationships with foster mothers and behavioral adjustment in foster care. Participants included 32 children, ages 9-13 years, who entered foster placement for the first time after a sustained relationship with a maltreating biological mother. Upon initially entering foster care, children's maternal and self-representations were significantly related to each other and to severity of maltreatment history but not to other factors believed to influence the quality of parent-child relationship (e.g., maternal mental health, partner stability). In addition, these representations significantly predicted children's subsequent views of their relationships with foster mothers. Finally, children's behavior in their foster homes was associated with maltreatment severity, internal representations assessed at entry into foster care, and to concurrent perceptions of their new foster mothers. These findings advance our understanding of foster placement's role in maltreated children's development and provide preliminary insight into the processes associated with the formation of potentially compensatory relationships.

Adolescent↗
PubMedDate not supplied

Emergency department utilization by children in foster care.

OBJECTIVE: To examine emergency department (ED) utilization of children in foster care using nationally representative data. METHODS: Cross-sectional analysis of the National Survey of Child and Adolescent Well-Being, Wave 1, which provided data for children ages 1 to 14 years in foster care for 1 year between October 1999 and December 2000. We identified children as having used the ED based upon foster parent responses to the question, "In the last 12 months, has your child gone to an emergency room or urgent care center (UCC) for an illness or injury?" We examined child and family demographic variables that were associated with having used the ED. RESULTS: The sample included 559 children in foster care. Thirty-one percent (95% confidence interval = 26%, 36%) of foster children had visited the ED or UCC in the past 12 months. Multivariate logistic regression analysis revealed that out of all children in foster care, children who had a chronic condition, children of younger age, and children with younger foster caregivers were significantly more likely to have used the ED. CONCLUSION: A sizeable proportion of children in foster care use the ED, and subgroups of these children have particularly high rates of ED use. An important component of providing a medical home for children in foster care should involve coordination of care around ED visits for this vulnerable group of children.

Adolescent↗
PubMed2005

Health of children adopted from Guatemala: comparison of orphanage and foster care.

OBJECTIVE: Since 1986, American parents have adopted >17300 children from Guatemala. This study assessed the health, growth, and developmental status of 103 Guatemalan adopted children (48 girls; 55 boys) after arrival in the United States. Physical evidence suggestive of prenatal alcohol exposure and adequacy of vaccinations administered were also reviewed. METHODS: Retrospective chart review was conducted of 103 children who were evaluated after arrival in the United States in an international adoption specialty clinic, and a case-matched study was conducted of a subgroup of 50 children who resided in either an orphanage or foster care before adoption. Mean age at arrival was 16 +/- 19 months. Before adoption, 25 children resided in orphanages, 56 resided in foster care, and 22 resided in mixed-care settings. The 25 children who had resided in orphanages before adoption were matched for age at arrival, interval from arrival to clinic visit, and gender with a child adopted from foster care. Health and developmental status of these matched pairs were compared, allowing the first direct comparison of children raised in orphanages or foster care before adoption. RESULTS: Mild growth delays were frequent among the children. Mean z scores for weight, height, and head circumference were, respectively, -1.00, -1.04, and -1.08. Children from foster care had significantly better z scores for height, weight, and head circumference than those from orphanage or mixed care. Among children who were younger than 2 years at arrival, growth measurements correlated inversely with age at arrival. Infectious diseases included intestinal parasites (8%) and latent tuberculosis infection (7%). Other medical conditions included anemia (30%), elevated lead levels (3%), and (using strict criteria) phenotypic facial features suggestive of prenatal alcohol exposure (28%). Adequacy of vaccine records from Guatemala was assessed: 28% met American Academy of Pediatrics standards for vaccine administration. Unsuspected significant medical diagnoses, including congenital anomalies and ocular, neurologic, and orthopedic problems, were found in 14%. Most children were doing well developmentally (80-92% of expected performance), but 14% had global developmental delays. Cognition, expressive and receptive language, and activities of daily living skills correlated inversely with age at arrival for children who were younger than 2 years at adoption. Among the 50 matched children, those who resided in foster care before adoption had better measurements for height, weight, and head circumference at arrival to the United States. Moreover, those who resided in foster care scored significantly better for cognitive skills than those who had previously resided in orphanages (96.3% of age-expected compared with 88.3% of age-expected); other skills did not differ between the 2 groups. No differences were found between the 2 groups of children related to prevalence of medical diagnoses or phenotypic evidence suggesting prenatal alcohol exposure. CONCLUSIONS: Guatemalan adoptees display similar overall patterns of growth and developmental delays as seen in other groups of internationally adopted children, although not as severe. Younger children had better growth and development (cognition, language, and activities of daily living skills) than older children, regardless of location of residence before adoption. Among children who were matched for age, gender, and interval from adoption to evaluation, those who had resided in foster care had better growth and cognitive scores than children who had resided in orphanages before adoption. These findings support the need for timely adoptive placement of young infants and support the placement of children in attentive foster care rather than orphanages when feasible.

Adoption↗
PubMedDate not supplied

Comparison of role perceptions of white and African American foster parents.

The number of U.S. children entering foster care is increasing faster than the number of available foster parents. Of particular concern are the growing number of African American children in foster care and the lack of African American foster parents to care for them. This study compares role perceptions of African American and white foster parents and provides information on recruiting African American foster parents. These foster parents are more likely than their white counterparts to feel responsible for facilitating the relationship between foster children and birthparents. They are more likely to accept responsibility for the roles of agency partner and emotional developer of the child. Implications include the need for agencies to develop recruitment models that are sensitive to the qualities African American families can bring to the foster parent role.

Adult↗
PubMed2004

Foster children with special needs: The Children's Aid Society experience.

Children in foster care have many health needs. This article presents the model of the Children's Aid Society (CAS) of New York City in addressing these needs. In addition to their regular foster care program, CAS developed the Medical Foster Care (MFC) in response to the growing number of boarder babies (children with medical conditions who are abandoned at hospitals), and the Therapeutic Foster Care (TFC) for foster children with emotional and behavioral mental health problems. The MFC serves 145 children considered medically fragile, as evidenced by congenital diseases such as heart disease, renal agenesis, cerebral palsy, seizure disorders and mental retardation. The TFC serves 50 children with severe levels of emotional and behavioral symptomatology. As is indicated by the extensive services offered through CAS's regular foster care program, as well as MFC and TFC, these children require specialized treatment. In addition, systems of information maintenance and exchange surrounding the health care of foster children need to be improved. Often agencies are ill-equipped to do adequate background checks on these young people and as a result deliver them to foster care situations where their health needs are not revealed and therefore not addressed. Health care providers also need to stay informed on the overall subject of foster care, as their voices will probably be crucial in ensuring that the extensive needs of these children are adequately represented to government, medical and other service providers.

Adolescent↗
PubMed1991

The attachments of children in foster care.

Subjects for this research were 52 foster children (mean ages 7 years, 11 months) and their natural and foster parents. Case history files provided information concerning reasons for placing the children in foster care. Foster parents completed the Parent/Child Reunion Inventory (Marcus, 1988) measuring the "quality of reunion behavior" following separation. Foster mothers also completed the Child Behavior Checklist (Achenbach & Edelbrock, 1983), and measures of adult empathy were collected from both foster parents. Foster care workers rated the quality and intensity of attachment between the child and all parents. Finally, foster children were interviewed concerning their social supports, perception of affection from adults, and the quality of their relationships with adults and friends. Results showed that behavior and school achievement problems were predictable from measures of the quality of attachment with parents. The mean number of behavior problems of foster children were found to be midway between clinical and nonclinical norm groups. Children's perceptions of friends' behavior and degree of control over friends were related to their adjustment. Case history variables were also related to behavior problems and attachment.

Adolescent↗
PubMedDate not supplied

Foster care of HIV-positive children in the United States.

A national study regarding the foster care of children identified as human immunodeficiency virus-positive (HIV-positive) was conducted in 1991. A survey form was sent to the administrators of the State agency responsible for foster care in each State, the District of Columbia, and U.S. Territories for a total sample size of 55. After followup, all 55 responded for a response rate of 100 percent. The number of children in foster care was ascertained for the current year and cumulatively. In 1991, 1,149 HIV-positive children were reported to be in foster care. Most States (49) had a general foster care policy and 21 had specific policies regarding care of a foster child who is HIV-positive. Measures and criteria used for recruitment were examined. In regard to recruitment policies, only seven States mandated recruitment of families specifically for children with HIV and acquired immunodeficiency syndrome. The major topics covered in training for HIV foster families included confidentiality, behavioral management, working with natural families, emotional factors, separation and loss, and others. Other issues discussed are foster parent training, supplemental services, later adoption possibilities, payments, and the expressed fears and doubts of foster parents caring for HIV-positive children. It is recommended that a national conference address the issues.

Child↗
PubMed1996

Foster home environments: a preliminary report.

This study evaluated the quality of developmental and emotional stimulation available to young children in their first foster home placement. Visits were made to 28 of 34 (82%) homes of children ages 2 to 6 years who were enrolled in a prospective study of foster care. Based on the results of the Home Observation for Measurement of the Environment (HOME) scale, 18% of homes were found to be understimulating. Multivariate analysis revealed that low HOME scores were related only to income level and not to other foster parent characteristics. Subscale scores showed that low HOME scores were due largely to lack of adequate play materials and limited interaction between the foster parents and the children. These results demonstrate great variability in the quality of foster home environments. Adjusting foster care subsidies according to foster parents' income levels, providing age-appropriate books and play materials, and additional training of foster parents should increase the developmental and emotional stimulation available to foster children.

Adult↗
PubMed2001

Effects of repeated cross-fosterings on preweaning behavior and growth performance of piglets and on maternal behavior of sows.

Extensive cross-fostering is widely used in early-weaning units in order to standardize and improve body weight at weaning. However, young suckling piglets develop teat fidelity and repeated cross-fosterings could go against this behavior. This experiment was therefore conducted to compare the behavior and growth of 13 control and 14 fostered litters. Once every 3 d (from d 1 to 16 of lactation), all piglets were weighed and three piglets were switched between two fostered litters. Their unfostered littermates were called residents. Behavior was recorded for 2 h after weighing and(or) adoption and during one nursing period 24 h later. Fights were more frequent (P < 0.05) in treated than in control litters during and between nursings at all ages of adoption except d 1. Most fights occurred between resident and fostered piglets (P < 0.001), except at d 1. Fights during nursing were still more frequent in treated than in control litters 24 h after adoption (P < 0.02), except at d 1 and 16. More piglets had skin lacerations in treated than in control litters except at d 1 (P < 0.05), and scratches were more frequent in fostered than in resident piglets at d 1 (P = 0.07), 7, 13, and 16 (P < 0.01). At all ages except d 1, failed nursings and snaps at piglets were more frequent in fostered than in control litters (P < 0.05), most snaps being directed at adopted piglets (P < 0.001). In fostered litters, sows spent 15 to 30% less time lying on their sides at d 4, 7, 13, and 16 (P < 0.05). Finally, adopted piglets were 13% lighter than controls at weaning (P < 0.001), whereas residents were heavier than adopted piglets (P < 0.05) but lighter than controls (P = 0.1). These data demonstrate that cross-fostering done repeatedly during lactation is stressful for piglets and sows and does not improve body weight at weaning.

Adaptation, Physiological↗
PubMed2004

Fostering procedures for orphaned infants in a breeding colony of African green monkeys.

We developed procedures to foster orphaned African green monkey infants to females with natural infants of a similar age to the foster infant (< 1 month). Our purpose was to assess the feasibility of fostering additional infants to females with natural infants. The subjects were 4 infants (age 1 to 5 days) that were removed from the natural mother because of neglect or trauma. The recipient females varied in parity (0 to 7 previous infants). Within 24 h of removal from the natural mother, the foster infants were presented to a group of potential recipient females by placing the foster infant directly into the cage of the female that demonstrated positive behavior toward the foster infant (reaching toward the infant and lip-smacking). Analysis of the behavioral data collected when the infants were 3 to 6 months of age indicated that foster mothers spent significantly more time nursing the natural infant alone, but the percentage time spent nursing both infants simultaneously was not significantly different than the time spent nursing either infant individually. No significant differences between weaning weight of the natural and foster infants or single infants were observed at 6 months of age. Overall our success rate at weaning (75%) suggests that fostering additional infants on females with a natural infant may be a viable strategy for raising orphaned African green monkeys and may prevent the development of abnormal behaviors that typically are manifested by nursery-reared infants.

Animal Husbandry↗
PubMed2005

A comparison of mental health problems in kinship and nonkinship foster care.

OBJECTIVE: Knowledge of the emotional and behavioural problems of children in kinship foster care is scarce. No data on such problems in European countries have been published. This study compares child psychiatric problems and placement characteristics of children living in kinship and nonkinship foster care. METHODS: A total of 214 children in kinship and nonkinship foster care, aged 4-13, participated in the study. The Child Behavioral Checklist (CBCL) was completed by their foster parents and demography and placement information was collected. RESULTS: Of the nonkinship group, 51.8 % scored above the borderline on the CBCL Total Problem score, as did 35.8% of the kinship group. The kinship group had fewer previous placements, were more often fostered within their local community and had more contact with their biological parents. Kinship foster parents had lower social status, in terms of educational level. Variables significantly related to high level of the CBCL Total problems score were male gender and location of foster home outside community of birth family. Positive outcome was significantly associated with placement within the child's own community, which in turn was related to kinship placement. CONCLUSIONS: Placement in kinship foster care should be considered as a viable possibility.

Adolescent↗
PubMed1987

Mental health care for foster children in California.

This paper reports on a study conducted to assess the health care needs of foster children in California. To evaluate foster children's mental health problems and the services provided to meet them, 154 program administrators, social workers, foster parents, and health care providers were interviewed in 14 counties. Foster parents and social workers were interviewed in groups, and foster parents and administrators also completed questionnaires. We found that although all counties care immediately for children who are injured, abused, or ill, only one county performs routine mental health evaluations of all children, and in most counties less than a third of children ever receive such evaluations. Informants identified mental health problems as more severe than medical problems in this population, and they identified four major barriers to access to appropriate therapy. Recommendations are that all children should receive comprehensive mental health evaluations, and procedures for immediate and ongoing care with consistent providers who are sensitive to foster children's needs should be included in case management plans, and covered by improved payment mechanisms. Additionally, communication, coordination and joint planning should be instituted among relevant agencies to address foster children's needs, and increased resources and training should be directed towards social service agencies and foster parents.

California↗
PubMed1999

Abuse of children in foster and residential care.

OBJECTIVE: There have recently been many debates in the UK about how to provide good care for children placed away from home. Professionals have realized that the level of child abuse in foster care and children's homes is high. This research examines the characteristics of physical and sexual abuse of children in foster and residential care in a city in England. The number of cases of abuse reported by pediatricians in this group was compared to the number reported by the same pediatricians for the population of Leeds as a whole. METHOD: This is a retrospective study of 158 children, fostered or in residential care who were involved in 191 episodes of alleged physical and/or sexual abuse assessed and reported by pediatricians over a 6 year period from 1990 to 1995 in Leeds, England. Details of the child including the reason for placement in care, their physical and mental health, abuse characteristics, including perpetrator and case management were studied. RESULTS (see Table 1): 158 incidents of abuse in 133 children in foster/residential care are described. In foster care, 42 children were physically abused, 76 were sexually abused, and 15 experienced both forms of abuse. In residential care, 12 children were physically abused, 6 were sexually abused, and 6 experienced both forms of abuse. In foster care 60% of sexual abuse involved girls and 60% of physical abuse involved boys. In residential care almost twice as many boys as girls were reported to be abused. Foster carers perpetrated the abuse for 41%, natural parents on contact for 23%, and children 20% of incidents. A significant proportion of abuse was severe with 1 death, 8 children with burns, 18 with genital, and 34 with anal penetration. Long-standing emotional, behavioral and learning difficulties were common. Most children (80%) had been abused prior to entry into care. Foster children were 7-8 times and children in residential care 6 times more likely to be assessed by a pediatrician for abuse than a child in the general population. CONCLUSIONS: Children in foster or residential care form an at risk group for maltreatment. Their special needs include additional measures to protect them from abuse.

Adolescent↗
PubMed2000

The development of attachment in new relationships: single subject analyses for 10 foster infants.

This paper presents single-subject analyses of newly developing attachment relationships in 10 foster infant-caregiver dyads. Using a diary methodology, at least 2 months of daily data were provided by foster parents on infants' attachment behaviors. Foster infant attachment was also assessed using the Strange Situation. Foster mother state of mind regarding attachment was measured using the Adult Attachment Interview. For eight infants, diary data revealed predominant patterns of attachment behavior emerging within 2 months of placement. In most cases, diary data predicted Strange Situation classifications. Both Strange Situation and diary data indicated that the three children placed in foster care before 12 months of age with foster parents having primary or secondary autonomous states of mind were classified as having secure attachments. The five children placed after 12 months of age showed predominantly insecure attachment behavior in the diary and were classified as insecure in the Strange Situation. Contingency analyses of behavioral sequences reported in the diary revealed that foster parents tended to complement their foster childrens' attachment behaviors.

Adult↗
PubMedDate not supplied

What do foster parents think of the natural parents? A comparative study.

By means of standardized case vignettes and rating scales, this study compared attitudes of short-term foster parents, professional social workers and parents in the general population respectively towards birth parents of abused children received into foster care. Significant differences arose between the foster parents and comparison groups on dimensions about issues relating to the desirability of foster care, restrictions on contact with birth parents and conditions under which the abused child might return to its family. Wide variation occurred both between individual foster parents and also in the degree of correspondence of views between the foster parents and each of the comparison groups on individual dimensions. Such an anomalous position, if unacknowledged, might affect outcomes of individual foster placements and hold implications for the recruitment, training and support of foster parents.

Analysis of Variance↗