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PubMed1980

Foster home characteristics and psychiatric patient outcome. The wisdom of Gheel confirmed.

Even with the emphasis on deinstitutionalization, mental health services are still skewed toward hospital and nursing home care. A relatively untapped resource that is likely to receive more attention is the foster home. We previously demonstrated, in a controlled study of psychiatric patients randomly assigned to foster care or continued hospitalization, that foster care produced better social adjustment within four months. From that study we examine characteristics of foster homes associated with the improvement in social functioning. Improved outcome was related to more children in the homes, fewer boarders, and smaller size. Too much stimulation in the environment, more supervision by foster care sponsors, and more intensive follow-up by social work staff was bad for schizophrenic patients but good for nonschizophrenic patients. Neither the sponsors' tolerance and expectation nor the cost of foster care was related to outcome. The size and composition of homes are important and attention needs to be given to finding an enriched environment that is neither too stimulating nor too sterile for schizophrenic patients.

Adult↗
PubMed1977

Examining foster care: a viable solution for placement of handicapped children?

Foster care for handicapped children has become a frequently used and even more frequently criticized procedure. Traditional methods of foster placement have resulted in a number of negative outcomes, especially for the placed children. Based on a review of some recent innovative foster care programs, this paper has isolated a number of options for the restructuring of the entire foster care delivery system. These options include: rigorous client evaluation, use of selection and training criteria for foster parents, matching of client needs to caregiver abilities in making placement decisions, and ongoing professional support and supervision after placement. Systematic consideration of these issues may help make foster care a more viable solution to the growing problem of home placement for handicapped children.

Age Factors↗
PubMed1983

An empirical analysis of behavioral and emotional problems of foster children as related to re-placement in care.

Foster care is seen as a temporary service. However, for many children, foster care involves years of long term care. Most professionals feel that if a child must remain in care, the number of foster homes or re-placements the child experiences should be minimized. Evidence suggests that this lack of stability has a detrimental effect on the child's psychosocial development. Even though the research evidence supports the negative impact of re-placement on the foster child, little empirical research has dealt with identification of factors associated with children likely to be re-placed. This article focuses on foster children with behavioral and emotional problems and analyzes the association of these problems with placement stability and continuity. The findings report that children with behavioral and emotional problems are replaced in foster care more often than those children without similar problems.

Affective Symptoms↗
PubMed1984

Government leadership to protect children from foster care "drift".

In the United States public concern about foster care drift is widespread. "Drift" means lengthy placement away from the natural family, without a clear goal to return the child or find some other permanent home. Concern is focused on the negative effect of lengthy foster care on the psychological health of the child, and also on the increasing cost of such placement. Recently, the federal government, in response to extensive testimony about these issues, passed landmark legislation designed to reduce foster care drift, the Adoption Assistance and Child Welfare Funding Act of 1980. Thus the government has now become a leader in child welfare planning. The law requires a reporting and tracking system so that no child already in placement becomes "lost in the system." In addition, all proposed foster placements are now hedged with requirements that there be clear purposes and goals to be achieved by such placements. In effect placements must be defended, tracked, and reviewed periodically. The new requirements pose a rebuke to the professions serving children which have failed to stem the increase in foster care, and to control and place a time limit on such interventions in the family. Federal leadership has created a political climate in child welfare planning. The regulations issued to implement the law in the Carter presidency differ from those of the current administration. The current policy of the government of the United States is to provide protection of the family from excessive foster care placements by child welfare agencies. This is support for greater autonomy for the family, a more conservative approach.(ABSTRACT TRUNCATED AT 250 WORDS)

Adoption↗
PubMed1988

Treatment of children in foster care: issues of collaboration.

Therapists assessing and treating children in foster care face unique issues, due to the complicated relational system generated by a foster placement. At a minimum, the mental health clinician must negotiate a role relative to the foster family, especially the foster parents, biological parents, and the Child Protective Service Agency (CPS) represented by the caseworker. The system of relationships and the ambiguous status of the child in foster care affects both the range of issues that need to be assessed to identify factors contributing to a child's problems and the context of possible interventions. The therapeutic relationship with the child is also affected by the child's understanding of and feelings about the connections, or lack of them, between the therapist and other meaningful adults in the child's life. This paper considers issues affecting the role of the therapist relative to each relationship and then considers the broader role of the therapist as an intervener in the foster care and protective service system.

Child↗
PubMed2006

Who disrupts from placement in foster and kinship care?

OBJECTIVE: To identify reliable, inexpensive predictors of foster care placement disruption that could be used to assess risk of placement failure. METHODS: Using the Parent Daily Report Checklist (PDR), foster or kinship parents of 246 children (5-12 years old) in California were interviewed three times about whether or not their foster child engaged in any of the 30 problem behaviors during the previous 24 h. PDR was conducted during telephone contacts (5-10 min each) that occurred from 1 to 3 days apart at baseline. Disruptions were tracked for the subsequent 12 months. Other potential predictors of disruption were examined, including the child's age, gender, and ethnicity, the foster parent's ethnicity, the number of other children in the foster home, and the type of placement (kin or non-kin). RESULTS: Foster/kin parents reported an average of 5.77 child problems per day on the PDR checklist. The number of problem behaviors was linearly related to the child's risk of placement disruption during the subsequent year. The threshold for the number of problem behaviors per day that foster and kinship parents tolerated without increased risk of placement disruption for these latency-aged children was 6 or fewer. Children in non-kin placements were more likely to disrupt than those in kinship placements. There was a trend for increased risk of disruption as the number of children in the home increased. CONCLUSIONS: The PDR Checklist may be useful in predicting which placements are at most risk of future disruption, allowing for targeted services and supports.

California↗
PubMed1988

Foster care.

The placement of children in foster care is a signal that families are in trouble and that our social system is struggling. Foster care, designed to provide remedial services to the child and family and thus to facilitate family reconstitution, often fails. Health care of children in foster care cannot be separated from the circumstances that led to their placement or from the structure and operation of the foster care system itself. Physicians caring for children in foster care should be aware of the challenges presented by these children's high rate of chronic illness and emotional problems and by the barriers imposed by the foster care system.

Child↗
PubMed1998

Foster parents of cocaine-exposed infants.

The purpose of this study was to describe the experience of foster parents of cocaine-exposed infants. A qualitative approach was selected because of the paucity of knowledge on the topic. Results showed foster parents observed alterations in physiological and behavioral health, developmental problems, and variability among infants related to these problems. Foster parents were concerned about the future development of infants. They felt the experience of living with a cocaine-exposed infant gave them a unique view of the effects of exposure. Parents found difficulties obtaining social services. Foster parents reported problems with access to and appropriateness of health care and identified difficulties arising from community reaction to foster parenting. Recommendations focused on the need for more research on social, developmental, and behavioral effects of cocaine exposure and increased attention to the needs and concerns of foster parents.

Adult↗
PubMed2003

[Children and adolescents in foster care: health problems and guidelines for their health care].

In Spain, between 8,000 and 10,000 children and adolescents enter foster or residential care every year. This article aims to provide a review to increase knowledge of the health problems of minors in foster care.Sixty-five percent of the studies consulted were performed in the USA, 25 % in Spain and 10 % in other developed and industrialized countries. These studies report that a high percentage of these minors present complicated and serious physical, mental, and/or developmental problems. However, no appreciable qualitative differences in the most frequent health problems presented by these minors have been observed and there is general consensus that the high-priority health needs are the provision of preventive and/or therapeutic psychopedagogic, psychiatric, dermatologic, dental, nutritional, ophthalmologic, respiratory and immunization services. Failure to identify and provide early treatment of the health needs of these minors not only adversely affects their quality of life and future physical, emotional and intellectual development, but can also increase their difficulties in adaptation while in foster care and their future social adaptation. Their permanent relationship with the biological or adoptive family when foster care stops could also be jeopardized. Therefore, all children and adolescents in foster care should receive initial health screenings, comprehensive assessments and monitoring of their physical, mental health, and developmental status. We provide guidelines for the healthcare of these minors, which should be of use to healthcare professionals taking care of these children and adolescents while they remain in foster care.

Adolescent↗
PubMed2006

A promising parenting intervention in foster care.

The purpose of this study was to evaluate the effectiveness of a 2-component intervention for biological and foster parent (pairs) to improve parenting practices, co-parenting, and child externalizing problems. Participants were biological and foster parents (N=128) of primarily neglected children (ages 3 to 10 years) placed in regular foster homes. Biological and foster parents were randomly assigned in pairs to the intervention (n=80) or a usual care (n=48) condition. Intervention families received a 12-week parenting course (Incredible Years) and a newly developed co-parenting component. Key findings included significant gains in positive parenting and collaborative co-parenting for both biological and foster parents at the end of the intervention. At follow-up, intervention parents sustained greater improvement in positive parenting, showed gains in clear expectations, and reported a trend for fewer child externalizing problems. Findings supported the feasibility of offering joint parenting training to meet the needs of participating families and demonstrated that the co-parenting construct applied to families in the foster care system was amenable to intervention.

Adult↗
PubMed2005

Providing a secure base: parenting children in long-term foster family care.

This paper reports on a longitudinal study of children growing up in long-term foster family care. It focuses attention on the challenges for foster carers in providing a secure base for foster children in middle childhood and early adolescence, who have come predominantly from backgrounds of abuse, neglect, and psychosocial adversity. Separation and loss in the children's lives, often through multiple placements, increase the likelihood of difficulties across a range of development. These children tend to be wary, distrustful, and controlling when they enter foster placements, but need from their carers many of the caregiving qualities most commonly described as providing a secure base in infancy. This study describes a model of parenting which uses four caregiving dimensions that are consistent with attachment theory and research: promoting trust in availability, promoting reflective function, promoting self-esteem, and promoting autonomy. A fifth dimension, promoting family membership, is added, as it reflects the need for children in long-term foster family care to experience the security that comes from a sense of identity and belonging. Qualitative data from the study demonstrates the usefulness of this model as a framework for analysis, but also suggests the potential use of such a framework for working with and supporting foster carers.

Child↗
PubMed1977

Foster placement for the older psychiatric patient.

The effect of age on foster care outcome was examined for 572 male psychiatric patients referred for foster care from five VA hospitals. Subjects were assigned randomly to preparation (experimentals) or continued inpatient care (controls.) Research staff collected data on social functioning, mood, activity, and adjustment. Only 79 (14%) were 60 years or older. Compared with younger patients, those 60 and over were more likely to be diagnosed as having chronic brain disease and less likely to be diagnosed as have schizophrenia. About 70% of the younger and older experimentals were placed into foster care. Alcoholics and persons with more hospitalizations were significantly less likely to be placed. Patients in foster care changed significantly compared with hospitalized controls by having less social dysfunction and better adjustment. Older subjects improved as a result of being seen in the hospital prior to placement but were not different from younger subjects in how they responded to the foster home. The study suggests that foster care is an appropriate and underutilized resource for elderly psychiatric patients.

Adaptation, Psychological↗
PubMed2006

Are we ignoring youths with disabilities in foster care? An examination of their school performance.

This study examined the extent to which the academic achievement of adolescents receiving both foster care and special education services differs from the performance of youths involved in only foster care, special education, or general education. Extant school data were collected on 327 students, ages 13 through 21, who attended school in a large urban school district in Oregon. The study also collected information about students' general foster care experiences, such as length of time in care and type and number of placements. Analyses revealed that foster care youths in special education typically demonstrated lower performance on academic variables in contrast to one or more of the comparison groups. These youths also appeared to experience more restrictive special education placements than youths in special education only. Although foster care or special education status alone appears to place a student at risk of academic difficulties, the negative impact of interfacing with both systems appears multiplicative. Greater attention, commitment, and time must be given to the educational needs of foster care youths with disabilities by both education and child welfare professionals.

Adolescent↗
PubMed2005

Prevalence of psychiatric disorders among older youths in the foster care system.

OBJECTIVE: To estimate the lifetime and past year prevalence rates of major psychiatric disorders in a sample of older youths in the foster care system, to examine the timing of disorder onset and system entry, and to explore variations in past year prevalence rates. METHOD: Using the Diagnostic Interview Schedule for DSM-IV, interviews were conducted with 373 17-year-old youths (90% of those eligible) in one state's foster care system between December 2001 and June 2003. RESULTS: : Sixty-one percent of the youths qualified as having at least one psychiatric disorder during their lifetime; of these youths, 62% reported onset of their earliest disorder before entering the foster care system. In addition, 37% of youths met criteria for a psychiatric disorder in the past year. The number of types of maltreatment experienced was the most robust predictor of psychiatric disorder among several maltreatment variables. There were no differences in prevalence rates for youths in kinship care and those in nonkin foster families. CONCLUSIONS: Older youths in the foster care system have disproportionately high rates of lifetime and past year psychiatric disorders. Results support recommendations for initial and periodic mental health assessments for these youths and mechanisms to continue mental health services for young adults transitioning out of the foster care system.

Adolescent↗
PubMed2006

Foster children's diurnal production of cortisol: an exploratory study.

Young children in foster care have often experienced inadequate early care and separations from caregivers. Preclinical studies suggest that early inadequate care and separations are associated with long-term changes in regulation of the hypothalamic-pituitary-adrenal (HPA) axis. In this study, the daytime pattern of cortisol production was examined among 55 young children who had been placed into foster care and 104 children who had not. Saliva samples were taken at wake-up, in the afternoon, and bedtime for 2 days. Average salivary cortisol values for each time of day were computed. A group (foster vs. comparison) time (morning, afternoon, night) interaction emerged, reflecting less decline in levels across the day for foster than comparison children. Daytime patterns were categorized as typical, low, or high. Children who had been in foster care had higher incidences of atypical patterns of cortisol production than children who had not. These differences suggest that conditions associated with foster care interfere with children's ability to regulate neuroendocrine functioning.

Caregivers↗
PubMed1991

Foster care for older adults: issues and evaluations.

"Adult foster care" is a label that has been applied to very diverse programs. Although adult foster care appears to be a potentially important element in the continuum of care for older adults, its assumptions and characteristic features have not been clearly explicated. In this paper, common assumptions underlying adult foster care are suggested, representative adult foster care programs are examined, and persisting issues discussed. The results suggest that, as yet, there is no consensus among practitioners as to what are reasonable goals for adult foster care, who should participate in such programs, and what constitutes evidence of program success. Until these issues are resolved, adult foster care is likely to remain an underutilized form of long term care for older adults.

Aged↗
PubMed2000

Specialized assessments for children in foster care.

OBJECTIVE: To investigate the differences in health problems identified and health services received by children newly entering foster care who participated in a comprehensive multidisciplinary program, compared with children newly entering foster care who received customary community-based services. METHODS: Using a 2-group quasiexperimental design, 120 young children entering foster care were enrolled in a multidisciplinary intervention program (n = 62) or were followed by customary care providers (n = 58). An interview with the foster parent; a complete medical examination; and a battery of developmental, psychological, speech/language, and motor assessments were completed for each child at baseline. Children in both groups participated in follow-up assessments at 6 and 12 months. RESULTS: No significant differences between the 2 groups existed in medical, educational, developmental, or mental health problems identified by foster mothers. However, children in the intervention group were more likely to be identified with developmental (56.5% vs 8.6%) and mental health problems (37.1% vs 13.8%) by providers than children in the comparison group. Children in the intervention group were also more likely to be referred for health services at baseline (71.0% vs 43.1%) and receive follow-up care at 6 and 12 months of age than children in the comparison group. CONCLUSIONS: Findings indicate that community providers identify medical and educational needs but do not recognize developmental and mental health needs of young children newly entering foster care. The discrepancies in the number of recommended services and follow-up care between the 2 groups make a case for the establishment of specialized services for children entering out-of-home care.

Child↗
PubMed2001

Children who return home from foster care: a 6-year prospective study of behavioral health outcomes in adolescence.

OBJECTIVE: Returning children to their biological families after placement in foster care (ie, reunification) has been prioritized with legislation. Comprehensive studies of child behavioral health functioning after reunification, however, have not been conducted. This study examined outcomes for youth who were reunified after placement in foster care as compared with youth who did not reunify. DESIGN: Prospective cohort. SETTING: Children who entered foster care in San Diego, California, and who remained in foster care for at least 5 months. Participants. A cohort of 149 ethnically diverse youth, 7 to 12 years old, who entered foster care between May 1990, and October 1991. Seventy-five percent of those interviewed at Time 1 were interviewed at Time 2 (6 years later). OUTCOME MEASURES: 1) Risk behaviors: delinquent, sexual, self-destructive, substance use, and total risk behaviors; 2) Life-course outcomes: pregnancy, tickets/arrests, suspensions, dropping out of school, and grades; 3) Current symptomatology: externalizing, internalizing, total behavior problems, and total competence. RESULTS: Compared with youth who were not reunified, reunified youth showed more self-destructive behavior (0.15 vs -0.11), substance use (0.16 vs -0.11), and total risk behavior problem standardized scores (0.12 vs -0.09). Reunified youth were more likely to have received a ticket or have been arrested (49.2% vs 30.2%), to have dropped out of school (20.6% vs 9.4%), and to have received lower grades (6.5 vs 7.4). Reunified youth reported more current problems in internalizing behaviors (56.6 vs 53.0), and total behavior problems (59.5 vs 55.7), and lower total competence (41.1 vs 45.0). There were no statistically significant differences between the groups on delinquency, sexual behaviors, pregnancy, suspensions, or externalizing behaviors. Reunification status was a significant predictor of negative outcomes in 8 of the 9 regression equations after controlling for Time 1 behavior problems, age, and gender. CONCLUSIONS: These findings suggest that youth who reunify with their biological families after placement in foster care have more negative outcomes than youth who do not reunify. The implications of these findings for policy and practice are discussed.

Child↗