Therapeutic moments are the key: foster children give clues to their past experience of infant trauma and neglect

Foster parents often despair over the lack of information about the past experience of the children in their care, particularly with children who have experienced infant trauma and neglect. In the context of family therapy these unknowns pose both a challenge and an opportunity. The author proposes that foster children gives clues to their past experiences in therapeutic moments, which the therapist may recognize as a result of her own inner conversation. In conjunction with a sound theoretical knowledge of infant trauma and neglect, these moments have the capacity to open a dialogue in the relationships between therapist, child and foster family. This dialogical process offers an opportunity for the child's past experience of infant trauma and neglect to be expressed in silence, and the foster parent's present experience to be heard in stillness, opening for them a way to go on beyond the family therapy sessions.     

Comparing Outcomes for Youth Served in Treatment Foster Care and Treatment Group Care

This study compared youth in the Florida Medicaid system prior to entry into treatment foster care or treatment group care, and compared outcomes in the 6 months after treatment. Florida Medicaid data from FY2003/04 through 2006/2007 along with Department of Juvenile Justice, Department of Law Enforcement, and involuntary examination data were used to examine youth receiving out-of-home treatment. Propensity score matching was used to examine the effect of out-of-home treatment on outcomes. Males, older youth, and youth with prior involuntary examinations, felony charges, misdemeanor charges, or inpatient psychiatric treatment were more likely to be placed in treatment group care. Treatment foster care placement was more likely for youth with prior treatment foster care episodes. Propensity matching results indicated that youth in treatment foster care had greater reductions in felony charges, and were less likely to return to out-of-home treatment in the following 6 months. While often placed in group care settings, youth with prior criminal justice encounters, especially for felony charges, may be better served in treatment foster care programs.     

A Role for Occupational Therapy in Foster Care

The purpose of this publication is threefold. First, it is an attempt to document the need for occupational therapy services within the foster care population. Second, it describes methods that can be used by occupational therapists to provide appropriate interventions to people affected by foster care. And third, it highlights the need for and identifies specific assessments that can be used to evaluate individuals affected by foster care and to measure the effectiveness of occupational therapy services delivered to foster care agencies.     

Support Needs and Satisfaction in Foster Care: Differences Between Foster Mothers and Foster Fathers

Family foster care is a vulnerable youth care intervention. The recruitment and retention of foster parents causes concerns. Offering support to foster mothers and foster fathers can augment the satisfaction and the intent of continuing fostering. Clearer understanding of the support needs of foster parents and their satisfaction with the foster care placement can lead to the identification of ways to improve the support offered. Although differences between foster mothers and foster fathers regarding their support needs and satisfaction can be expected, knowledge about these differences is nonexistent. Differences in support needs and satisfaction between 86 foster mothers and foster fathers who reported on 120 foster children were examined. No differences between foster mothers and foster fathers were found. Both foster parents had higher support needs regarding dealing with the birth parents compared to support needs in handling problem behavior of the foster child. For both foster mothers and foster fathers satisfaction with collaboration with the foster care worker, satisfaction with recognition experienced and satisfaction with reunification of the foster child, did not differ across these aspects. Satisfaction of foster parents can be increased by keeping in balance the rights and needs of birth parents and those of foster parents. Acknowledging that foster parents are experts on their foster child and consulting them on important decisions will also contribute significantly to their satisfaction.     

Predictors of Placement Outcomes in Treatment Foster Care: Implications for Foster Parent Selection and Service Delivery

Treatment foster care (TFC) is a normalizing environment in which to treat those children whose particular needs are not addressed in traditional foster care and for whom an institutional setting is a restrictive and unnecessary alternative. However, when the foster care placements of these emotionally and behaviorally disturbed children fail, as they often do, the children are shifted from one home to another without the opportunity to experience permanence or emotional attachment, resulting in poor adjustment to foster care. Placement stability, which depends in part upon effective matching of foster children with potential foster families, is critical for achieving positive outcomes in TFC. Yet, there is a dearth of information to guide placement agencies in making decisions about matching foster children with families. Moreover, once a successful match has been made, it is equally vital that service delivery be of high quality so that permanence is maintained. We review research on the predictors of positive outcomes in foster care, focusing on studies involving emotionally or behaviorally disturbed children, and provide recommendations for selecting foster parents and for ensuring high quality foster care services and placement stability.     

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.     

Ethical Considerations for the Treatment of Youth in Foster Care

Mental health clinicians treating youth in foster care face several ethical challenges, such as competence for treating youth in foster care, understanding who can provide informed consent, and confidentiality. However, few articles have addressed these ethical concerns or provided recommendations for clinicians on how to navigate these issues. This article presents a brief summary of the foster care system, an overview of the major ethical challenges clinicians may encounter when treating youth in foster care, areas of the American Psychological Association’s Ethics Code, Code of Ethics of the National Association of Social Workers, and American Counseling Association Code of Ethics most germane to the treatment of youth in foster care, and general recommendations for clinicians treating this population.     

The Experiment of Foster Care

We sought to provide a new framework for understanding the training and ongoing support of foster parents. The experiences of authorized foster parents were viewed in the context of an experiment, whereby foster parents entered an out-of-home care placement with preconceived ideas and expectations of what the provision of care would be like. We have investigated the experience of foster care from the perspective of the foster parent who tests expectations of providing care as one might conduct any experiment. Focus group discussion yielded five global domains of foster care experience: birth family, motivation, agency influences, relationship impacts, and attachment. Foster carers commonly described these domains as central to the overall experience of providing foster care. Furthermore, specific experiences within each domain were seen to either encourage or discourage the further provision of foster care. Individual interviews regarding the practical experiences related to these domains uncovered struggles of foster parents who sought to understand their role identity as a “foster parent”, and their self identity as a “mother”. We discuss implications arising from the experience of these domains of care and their related struggles.     

A Triage Tool to Assess Unmet Health Needs for Children Entering Foster Care

Children in foster care have high levels of health care needs, many of which are unmet at foster care entry. Health care coordination (HCC) is essential to ensure unmet needs are addressed rapidly. Data is lacking about how best to triage children at foster care entry so limited HCC resources can be allocated most effectively. Therefore, we aimed to: (1) utilize a Triage Tool (TT) at foster care entry to stratify children based on unmet health care needs and (2) determine if the TT is an accurate predictor of health care utilization as indicated by cost during a child’s first few weeks in care. A TT was developed and utilized during the initial foster care health exam (IFCHE) to stratify children based on unmet needs. Medicaid records were reviewed to determine health care utilization and cost during the first 60 days post-IFCHE. Most children (61.6%) had the lowest level of unmet needs (Level 3), 29.5% had a moderate level of unmet needs (Level 2), and 9.9% had the highest level of unmet needs (Level 1). Medicaid claims review revealed that triage level did not correlate to health care utilization or costs during the first 60 days post-IFCHE. Youth placed in a group home incurred significantly higher costs than those placed in foster homes. These results suggest that the TT is useful clinically but does not predict health care utilization and costs during the first weeks in care. Group home placement incurs more cost than foster home placement, independent of triage level assigned.     

Prereading Deficits in Children in Foster Care

Reading skills are core competencies in children's readiness to learn and may be particularly important for children in foster care, who are at risk for academic difficulties and higher rates of special education placement. In this study, prereading skills (phonological awareness, alphabetic knowledge, and oral language ability) and kindergarten performance of 63 children in foster care were examined just prior to and during the fall of kindergarten. The children exhibited prereading deficits with average prereading scores that fell at the 30(th) to 40(th) percentile. Variations in prereading skills (particularly phonological awareness) predicted kindergarten teacher ratings of early literacy skills in a multivariate path analysis. These findings highlight the need for interventions focused on prereading skills for children in foster care.     

Foster Care and the Helping Professions

This article combines a foster parent's and an educator's view of working with children in foster care placements. Counseling a child who has been removed from the home environment requires a real sensitivity to the internal devastation that may be taking place and the coping behaviors associated with that separation process.     

Factors affecting foster care breakdown in Spain

Breakdown of foster care has been defined as the situation in which one of the involved parties terminates the intervention before having achieved the goals established for the case plan. This work presents a study carried out with a Spanish sample of 318 closed cases of children who were placed in foster homes and kinship care. The data were collected through the exhaustive review of the child protection and foster placement files, complemented with interviews of the welfare workers in charge of each case. The rate of breakdown of the entire sample was 26.1%, although it was significantly different in kinship care (19.7%) and foster care (31.2%). The results of this study indicate that the variables related to breakdown depend on the placement modality, either in foster care or kinship care. In the first case, the variables related to the child's characteristics are noteworthy, especially behavior and academic problems, with special relevance in the 9-12-year-old group, and in children who were previously in residential care. In contrast, in kinship care, the parents' problems (prison, mental health) and having some measure of guardianship are the most important. The fact of undergoing foster placement after having lived in various residential homes is transcendental. Lastly, the availability of economic resources and even the foster carers' studies seem to be related to foster breakdown.     

Transitioning from congregate care: Preparation and outcomes

Of particular concern to child welfare professionals working with youth in foster care is the quality of services rendered to youth in foster care who are imminently making the transition to adulthood and independence, i.e., those at risk for aging out of foster care, many of whom live in congregate care facilities. This qualitative study focuses on the experiences of youth in congregate care in New York City's foster care system, the effectiveness of efforts to prepare youth for life after foster care, and post-discharge outcomes for youth, particularly when discharged to independent living. The study included interviews with professionals as well as young adults who had exited foster care after placements in congregate care settings. Results indicated that professionals and young adults were concerned about the quality of independent living preparation, viewed housing as a serious issue for youth exiting foster care, attributed youth's lack of employment to poor pre-discharge educational and work preparation services, and emphasized the importance of personal connections after youth leave care.     

Emotional Intelligence: An Opportunity for Occupational Therapy

Emotional intelligence theory developed within the psychology and business fields and is described as an ability to monitor emotions and to use the information to guide thinking and problem solving. Emotional intelligence skills are needed by occupational therapy practitioners to support therapeutic use of self, promote client-centered care, and foster communication skills within the workplace. A scenario illustrates how emotional intelligence supports the therapeutic use of self during a clinical interaction. The Mayer Salovey Caruso Emotional Intelligence Test is introduced as a resource for occupational therapy practitioners to measure and develop therapeutic relationship skills based upon emotional intelligence research.     

Providing therapy to children and families in foster care: a systemic-relational approach

Foster care is a system created to protect children from an unsafe home environment yet multiple foster home placements, conflictual or nonexistent relationships between foster parents and birth parents, long, drawn out court battles, and living in an on-going state of not knowing when or if they will be going home are just some of the challenges many children in care are expected to manage. This paper presents a guide for therapists working with families involved in foster care. Utilizing ideas from the postmodern therapies and structural family therapy, suggestions will be provided about who needs to talk to whom about what, when to have these necessary conversations, and how to talk to people in a way that mobilizes adults to take action for the children, with the goal of minimizing postplacement trauma, strengthening and repairing relational bonds, and moving children out of foster care and into permanent homes as quickly as possible.     

The foster parenting center: A multidisciplinary resource for special needs preschoolers

A combined foster parent training and preschool education program for developmentally delayed and emotionally disturbed children is described. This program was organized and run by a multidisciplinary group of independent professionals, who served as a liaison with a foster care agency. The goals of preventing placement breakdown by giving early attention to problems, and of improving foster parents' abilities to manage difficult children were met at modest cost to the agency. The model can be replicated in other communities to improve the quality of foster care provided to young children.     

Mental Health Problems of Children in Foster Care

We compared the rates of mental health problems in children in foster care across three counties in California. A total of 267 children, ages 0 to 17, were assessed two to four months after entry into foster care using a behavioral screening checklist, a measure of self-concept and, in one county, an adaptive behavior survey. Results confirmed previous research and indicated consistently high rates of mental health problems across the three counties. Behavior problems in the clinical or borderline range of the CBCL were observed at two and a half times the rate expected in a community population. Fewer children fell within the clinical range on the self-concept measure. No significant differences in rates between the three county foster care cohorts were observed, despite the different demographic characteristics of the counties. On the adaptive behavior scale, the mean scores for children in foster care were more than one standard deviation below the norm. Our findings suggest that the most important mental health screening issue with children in foster care is to identify what specific mental health problems need to be addressed so that the most effective treatment services can be provided.     

The effects of early foster care intervention on attention biases in previously institutionalized children in Romania

Children raised in institutions experience psychosocial deprivation that can negatively impact attention skills and emotion regulation, which subsequently may influence behavioral regulation and social relationships. The current study examined visual attention biases in 8‐year‐old children who were part of the Bucharest Early Intervention Project (BEIP). Relations among attention biases and concurrent social outcomes were also investigated. In early childhood, 136 children abandoned at birth or shortly thereafter into institutional care were randomized to receive a high‐quality foster care intervention or care‐as‐usual within the context of the Bucharest Early Intervention Project (BEIP). At 8 years of age, 50 care‐as‐usual, 55 foster care, and 52 community controls performed a behavioral dot‐probe task, and indices of attention biases to threat and positive stimuli were calculated. Concurrent data on social behavior were collected. Children placed into the foster care intervention had a significant attention bias toward positive stimuli, while children who received care‐as‐usual had a significant bias toward threat. Children in the foster care intervention had a significantly larger positive bias when compared to the care‐as‐usual group. A positive bias was related to more social engagement, more prosocial behavior, less externalizing disorders, and less emotionally withdrawn behavior. The magnitude of positive bias was predicted by age of placement into foster care among children with a history of institutionalization. An attention bias towards positive stimuli was associated with reduced risk for behavioral problems amongst children who experienced early psychosocial deprivation. Research assessing attention biases in children experiencing early environmental stress may refine our understanding of the mechanisms underlying risk for later psychiatric and social disorders and inform prevention efforts.