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PubMed2004

Are foster parents reliable informants of children's behaviour problems?

BACKGROUND: Clinicians and researchers primarily measure behavioural and emotional problems of children in foster care from carer-report checklists. Yet the reliability of these reports is not adequately established. The present study examines one indicator of reliability for foster parent checklist reports: interrater agreement between foster parents and teachers. METHODS: Estimates of interrater agreement of foster parent and teacher responses on the cross-informant scales of the Child Behaviour Checklist (CBCL) and the Teacher Report Form (TRF) were obtained for 47 children in long-term foster care, aged 5-11 years. The estimates included calculations of agreement for continuous measures of problem behaviour, as well as for categorical determinations of clinically significant behaviour. RESULTS: Correlations of CBCL and TRF mean raw scores for the total problems (r = 0.71) and externalizing (r = 0.78) scales exceeded those described in prior studies of parent-teacher agreement, while correlation for internalizing scores (r = 0.23) was similar to that found previously. Teachers and foster parents demonstrated moderate to good agreement (kappa = 0.70-0.79) in identifying clinically significant total problems and externalizing problems, but poor agreement in identifying internalizing problems. CONCLUSIONS: Discrepancies between these and prior findings are discussed. For children in long-term foster care, foster parents or teachers may be used as informants for total problems, externalizing problems, and social-attention-thought problems. The reliability of data on internalizing symptoms is less certain.

Child↗
PubMedDate not supplied

Self-protection in adolescents in foster care.

PROBLEM: Adolescents in long-term foster care experience significant health and mental health problems. Little is known about their perceptions of the impact of foster care. METHOD: Seventeen adolescents were interviewed in their foster group homes. Dimensional analysis was used to develop theory on the impact of foster care. FINDINGS: Adolescents in foster care engaged in self-protection strategies secondary to experiences of devaluation and uncertainty in foster care, including guarding foster child status, maintaining a defensive posture, distancing self, and keeping relationships superficial. Self-protection resulted in a veneer of self-reliance and social detachment. CONCLUSIONS: Strategies are suggested to address devaluing experiences and promote positive identity development in foster care.

Adaptation, Psychological↗
PubMed2006

This is my child: differences among foster parents in commitment to their young children.

In this study, the authors examined variables associated with foster mothers' level of commitment to their young foster children, who ranged in age from 5 months to 5 years. Commitment was assessed using a semistructured interview known as the "This Is My Baby" interview (TIMB; Bates & Dozier, 1998). Among 84 foster parent-child dyads, foster mothers who had fostered more children previously showed lower levels of commitment than did foster mothers who had fostered fewer children. Commitment also was associated with child age at placement, with foster parents showing higher levels of commitment to children who were placed at younger ages than to children who were placed at older ages. Commitment predicted the stability of the relationship, with higher levels of commitment associated with a greater likelihood of adoption or long-term placement. These results suggest the importance of designing a child welfare system that will enhance caregivers' ability to commit to the children for whom they provide care.

Adult↗
PubMed2003

Continuity of care for children in foster care.

OBJECTIVE: To compare the continuity of care experienced by children who are in foster care with that of children who are not in foster care and are covered under Medicaid managed care and Medicaid fee-for-service (FFS). METHODS: This retrospective cohort study used Medicaid claims/encounter data from Washington state. A total of 903 children who were in foster care and continuously enrolled in Medicaid for 24 months (1998-1999) were matched by age, gender, and rural/urban residence to 903 Medicaid managed care enrollees and 903 FFS beneficiaries who were not in foster care. Indices of the continuity of primary care experienced were calculated for each patient, and differences in continuity among the cohorts were assessed by running 3 multiple linear regression models for all possible pairings of cohorts, controlling for age, gender, rural/urban residence, and total number of primary care visits. RESULTS: Foster care status was associated with decreased continuity of care relative to nonfoster managed care status (beta = -0.12; 95% confidence interval [CI]: -0.15 to -0.09). Nonfoster FFS status was associated with lower continuity than managed care (beta = -0.09; 95% CI: -0.12 to -0.06) and slightly higher continuity than foster care status (beta = 0.03; 95% CI: 0.01-0.06). CONCLUSION: Although not dramatically different, continuity seems somewhat lacking for children in foster care. It is unclear to what degree the observed difference is confounded by the managed care/FFS distinction. As the enrollment of children in foster care into managed care plans has been controversial, efforts to promote the consistency of contact with providers while maintaining the flexibility afforded by FFS coverage seem warranted.

Adolescent↗
PubMedDate not supplied

Promoting family-centered care with foster families.

There has been a tremendous increase in the need for foster families since the 1980s largely because of the effects of drug abuse on the child and the biological family. As many as 500,000 children are currently living with foster families. Many children living with foster families were exposed to drugs before birth. Even those not exposed before birth demonstrate the effects of having lived with drug-abusing family members. Family life for these children is very often chaotic and unpredictable. There are increased health care needs for foster children due to drug-exposure and neglect. Yet, research suggests that the health care needs of foster children are often neglected. Foster families report that their concerns and needs are, frequently, neither recognized nor addressed by health professionals. Pediatric nurses can improve health care by increasing their awareness of the special needs of foster families and foster children.

Adult↗
PubMed2000

Health care needs of children in the foster care system.

Nearly 750 000 children are currently in foster care in the United States. Recent trends in foster care include reliance on extended family members to care for children in kinship care placements, increased efforts to reduce the length of placement, acceleration of termination of parental rights proceedings, and emphasis on adoption. It is not clear what impact welfare reform may have on the number of children who may require foster care placement. Although most children enter foster care with medical, mental health, or developmental problems, many do not receive adequate or appropriate care while in placement. Psychological and emotional problems, in particular, may worsen rather than improve. Multiple barriers to adequate health care for this population exist. Health care practitioners can help to improve the health and well-being of children in foster care by performing timely and thorough admission evaluations, providing continuity of care, and playing an active advocacy role. Potential areas for health services research include study of the impact of different models of health care delivery, the role of a medical home in providing continuity of care, the perception of the foster care experience by the child, children's adjustment to foster care, and foster parent education on health outcomes.

Adolescent↗
PubMed2004

Therapeutic foster care for the prevention of violence: a report on recommendations of the Task Force on Community Preventive Services.

In therapeutic foster care programs, youths who cannot live at home are placed in homes with foster parents who have been trained to provide a structured environment that supports their learning social and emotional skills. To assess the effectiveness of such programs in preventing violent behavior among participating youths, the Task Force on Community Preventive Services conducted a systematic review of the scientific literature regarding these programs. Reported and observed violence, including violent crime, were direct measures. Proxy measures were externalizing behavior (i.e., behavior in which psychological problems are acted out), conduct disorder, and arrests, convictions, or delinquency, as ascertained from official records, for acts that might have included violence. Reviewed studies assessed two similar interventions, distinguished by the ages and underlying problems of the target populations. Therapeutic foster care for reduction of violence by children with severe emotional disturbance (hereafter referred to as cluster therapeutic foster care) involved programs (average duration: 18 months) in which clusters of foster-parent families cooperated in the care of children (aged 5-13 years) with severe emotional disturbance. The Task Force found insufficient evidence to determine the effectiveness of this intervention in preventing violence. Therapeutic foster care for the reduction of violence by chronically delinquent adolescents (hereafter referred to as program-intensive therapeutic foster care) involved short-term programs (average duration: 6-7 months) in which program personnel collaborated closely and daily with foster families caring for adolescents (aged 12-18 years) with a history of chronic delinquency. On the basis of sufficient evidence of effectiveness, the Task Force recommends this intervention for prevention of violence among adolescents with a history of chronic delinquency. This report briefly describes how the reviews were conducted, provides additional information about the findings, and provides information that might help communities in applying the intervention locally.

Adolescent↗
PubMedDate not supplied

Gay, lesbian, and bisexual foster parents: strengths and challenges for the child welfare system.

Historically, a shortage of skilled and dedicated foster parents has existed in America. Lesbian, gay, or bisexual (LBG) foster parents have received little attention in the published literature. This article documents the challenges and successes of a group of 60 LGB foster parents. All participants provided foster parenting for public (state or county) agencies. The primary successes of this group included meaningful and gratifying parenting and successful testing of whether adoption might be a natural next step after foster parenting. The primary challenges included insensitive, inappropriate, and difficult social workers; state or local laws that worked against successful foster parenting by LGB adults; failure to recognize parents' partners; and lack of support by the system to acknowledge the important role of LGB parents. Numerous recommendations are identified for improving how LGB foster parents are supported within child welfare systems including foster parent and social worker training in LGB issues.

Adult↗
PubMedDate not supplied

The role of foster parents in helping young people develop emancipation skills.

The current focus on preparing youths in foster care for emancipation has largely ignored the critical role foster parents have always played in preparing youths to leave their homes and take their place as successful adults in our society. To assure that programs to enhance youths' skills and abilities to function responsibly are fully effective, they must include foster parents. In doing so, they will exponentially increase the hours of service and training available to eligible youths and develop a resource that will be available to future youths after funds are redirected. It is unrealistic, however, to expect foster parents to provide all of the help that most youths in foster care need. Foster family support and training must be seen as one dimension of an integrated approach that provides all youths with a variety of resources but is specific to the needs of each youth. With appropriate support and training, foster parents can assume professional responsibility for assuring that such plans are implemented, and that youths leaving foster care have what they need to emancipate successfully.

Activities of Daily Living↗
PubMedDate not supplied

The experience of family foster care in Malawi: a preliminary investigation.

This preliminary investigation into family foster care in Malawi set out to provide information on the Malawi government family foster care structure primarily through the qualitative experience of foster caregivers. A semistructured interview schedule was used to interview 24 foster parents, who were selected from a government family foster care register, in two regions of Malawi. The study revealed that cultural factors influenced various aspects of family foster care, ranging from the caregivers' decision to foster children to the caregivers' determination not to disclose to the children that they were fostered. Social and economic factors also played a role, particularly with regard to some shortcomings in service delivery.

Adaptation, Psychological↗
PubMed1978

Physical and neuromotor development of progeny of pyridoxine-restricted rats cross-fostered with control or isonutritional dams.

Female rats were fed diets containing graded levels of pyridoxine throughout gestation. At parturition, the pups were cross-fostered with a dam which had been fed the same diet as the biological mother throughout gestation (an isonutritional foster mother), or with one which had received a control diet containing 400% of the National Research Council recommendations for B6 throughout gestation (a control foster mother), or were left to suckle the biological mother. Physical, neuromotor, and reflexological development of the pups was assessed throughout the 3 week lactation period. There were no significant differences between pups nursed by their biological mothers and by isonutritional foster mothers. Growth, reflex acquisition, and neuromotor activities were impaired in pups subjected to pyridoxine restriction during gestation. Acquisition of a number of reflexes and time spent in neuromotor activities were responsive to cross-fostering with a control foster mother but the deficits were not completely eliminated. Growth was only slightly affected by cross-fostering and acquisition of audicular startle and negative geotaxis was not affected by the nature of the foster mother. The latter reflexes are apparently determined directly by the gestational nutrition of the fetus whereas other reflexes and neuromotor activities are influenced by long-term effects of pyridoxine restriction on the postnatal performance of the dam as a mother, in addition to being directly influenced by maternal diet during gestation.

Animals↗
PubMed1991

Mineral status of mice suckling early-, mid- and late-lactating foster dams.

We have demonstrated that the zinc (Zn) concentration of mouse milk declines significantly over the lactation period. Pups radiolabeled in utero with 65Zn were forward-fostered (FF) to nonradiolabeled dams at a later stage of lactation to study the effects of early milk deprivation. Other groups of radiolabeled pups were back-fostered at 5, 10 and 15 days of age to a nonradiolabeled dam who had just given birth; this provided additional colostrum during the suckling period. Litters fostered at birth to an unlabeled dam at d 0 of lactation were used as controls. Weight gain of FF litters decreased and signs of Zn deficiency increased as the foster dam's days of lactation increased. The Zn concentration of kidney, brain and plasma tended to decrease with increasing lactation days of the foster dam. Tibia Zn concentration declined progressively as the lactation days of the foster dam increased, and the concentration of calcium also was lower in all three groups of FF litters than in controls, indicating that bone calcification may have been impaired. Kinetic data proved to be a more sensitive index of Zn status than tissue Zn concentration. The biological half-life of whole-body 65Zn for FF suckling mice increased in a linear fashion with increasing lactation days of the foster dam; whole-body retention of 65Zn for back-fostered litters did not differ from that for controls. Brain, small intestine, kidney muscle, plasma and tibia of pups FF to late-lactating dams seemed to have greater retention of Zn than did controls. Thus, deprivation of early milk impaired growth and development of the mouse neonate despite some ability to conserve Zn.

Animals↗
PubMed1994

Types and frequency of child maltreatment by family foster care providers in an urban population.

Types and frequency of child abuse and neglect reports in family foster care in Baltimore, Maryland as compared to reports among nonfoster families are reported. Data on maltreatment incidents in foster homes were abstracted from Child Protective Services investigation records for the years 1984-1988. Comparisons were made to community reports. Results indicated that foster families had over a three-fold increased frequency of maltreatment reports as compared to nonfoster families. Report frequency was highest for physical abuse with a seven-fold risk of report as compared to nonfoster families. Overall, 20% of foster care reports were substantiated as compared to 35% of nonfoster reports, although the risk of having a substantiated report was significantly higher in foster care. The distribution of report types in foster care differed from those in the community with physical abuse the most frequent allegation in foster care, as compared to neglect as the most frequent allegation in the community. Explanations for these findings including differences in criteria for report and substantiation are advanced.

Adolescent↗
PubMed1988

The effect of child fostering on feeding practices and access to health services in rural Sierra Leone.

In Sierra Leone, where infant and child mortality rates are quite high, a large proportion of small children from 1 to 5 yr are fostered: living away from their mothers. This paper examines the relationships between fosterage and child feeding practices and children's access to Western medical care. Ethnographic data from field studies in Sierra Leone are combined with quantitative data from Serabu Hospital, which show that fostered children are underrepresented in hospital admissions and that young fosters present more problems of malnutrition. (Fostered girls appear to be at more risk in both these categories than boys.) Unlike young fosters, however, older ones do not appear to be at more risk than children with mothers. We draw connections between these results and patterns of intra-household discrimination in food allocation and access to medical treatment for young fostered children: especially those sent to elderly rural caretakers. Finally, we examine the implications of the findings for applied issues, arguing that fostered children may slip through the cracks of maternal-child health care programs.

Child↗
PubMed2002

Interventions for foster parents: implications for developmental theory.

All children who enter foster care have experienced disruptions in their relationships with caregivers, and many have experienced maltreatment. Studying the effects of these adverse early experiences can inform developmental theory. In particular, insight can be provided regarding sensitive periods in the development of attachment and self-regulatory capabilities. The quality of surrogate caregivers varies as a function of both the intervention services provided and foster parent characteristics. Studying the effects of foster parent quality can suggest which aspects of child functioning are more or less canalized at various developmental periods. This paper considers salient developmental issues of infancy, preschool years, middle childhood, and adolescence and examines ways in which these issues may present special difficulties for foster children. Across development, foster care is associated with difficulties regulating behaviors, emotions, and physiology. Thus, conditions associated with foster care placement (e.g., disruptions in care, maltreatment) appear to affect very basic and fundamental regulatory processes. Interventions have been designed that target developmentally specific manifestations of regulatory difficulties. Although the literature regarding evidence-based interventions for foster parents is quite limited, preliminary findings provide some evidence that nurturing, responsive care can serve to partially remediate early deficits. These findings suggest that stable and nonfrightening care is essential for normal development. Nonetheless, even in the case of quite adverse early experience that results in problematic child outcomes, there is some evidence that the development of many systems remains relatively plastic.

Adolescent↗
PubMed2006

The impact of foster care on development.

Foster care is a protective intervention designed to provide out of home placement to children living in at-risk home environments. This study employs prospective longitudinal data (N = 189) to investigate the effects of foster care on the development of child behavior and psychological functioning taking into account baseline adaptation prior to placement and socioeconomic status at the time of placement. Comparisons were made among three groups: children who experienced foster care, those who were maltreated but remained in the home, and children who had not experienced foster care or maltreatment despite their similarly at-risk demographic characteristics. In the current sample, children placed in out of home care exhibited significant behavior problems in comparison to children who received adequate care, and using the same pre- and postplacement measure of adaptation, foster care children showed elevated levels of behavior problems following release from care. Similarly, children placed into unfamiliar foster care showed higher levels of internalizing problems compared with children reared by maltreating caregivers, children in familiar care, and children who received adequate caregiving. Findings suggest that outcomes related to foster care may vary with type of care and beyond the effects associated with maltreatment history, baseline adaptation, and socioeconomic status.

Child↗
PubMed1999

Essential case management services for young children in foster care.

A growing number of children in the United States are being placed into foster care. Past studies indicate that effective case manager interventions have helped foster families with a variety of different problems. This study enrolled a randomly selected sample of 130 children under age four who had been newly placed into foster care. The purpose of this study was to identify the services needed by foster care families and determine which services require the most case manager effort. Consistent with other research, many foster care children in this study exhibited developmental, medical and psychosocial concerns. Nevertheless, we found that it was services aimed at the foster care parents, rather than the foster care children, that required the most labor-intensive case management services.

Case Management↗
PubMed1997

The substitutability of adult foster care for nursing home care in Oregon.

OBJECTIVES: This study investigates the degree of substitutability of adult foster care for nursing home care in Oregon. METHODS: Using three tests, the authors determined (1) the extent to which an additional adult foster care resident in a county reduces the number of nursing home residents in that county, (2) which characteristics of residents and facilities are important in sorting residents into either nursing homes or adult foster care facilities, and (3) the price elasticity of demand for adult foster care, using the county as the unit of observation. RESULTS: It was found that for every additional foster care resident in a county, a nursing home loses 0.85 residents-almost a one-to-one substitution ratio. CONCLUSIONS: Despite the high degree of substitutability, residents perceive important differences in the characteristics of the two forms of care. Indeed, private residents are, on average, willing to pay twice as much for nursing home care as for adult foster care, suggesting that these differences are important. Finally, private consumers are sensitive to price differences among adult foster care facilities. The implications for policy are discussed.

Adult↗