Child welfare research: advances for practice and policy

The period of compulsory school attendance is a mentally very challenging period for children in foster care, which can be impacted by complex developmental trauma stemming from the child's experience in foster care with cumulative and chronic traumatic events in his/her biological family. These events have taken place over a long period of time in interpersonal relationships usually related to caregivers, in the form of abandonment of the child by the caregiver, changing caregivers, lack of safe space and necessary support for the child from the family and school, and/or deficiencies in the provision of coordinated health and social care for both the child and the foster parents. The paper presents research findings supported by a statistical analysis of health and school difficulties in children in foster care related to their school attendance. The purpose of the research was to support the quality and coordination of services of non-profit organizations providing social, health and educational services to foster families and their children during school attendance to support the school success and well-being of children. The study was implemented as part of a dissertation at the University of South Bohemia in České Budějovice in the Czech Republic on the topic of promotion of the health, social and psychological well-being of school-aged children in the context of their school and family environment. The authors carried out a questionnaire survey in the Czech Republic among a selected sample of respondents, who were foster parents of children aged 6 to 15 attending primary school in the Pardubice Region. In a total sample of 102 respondents, we identified two different groups. One group – 64 respondents with healthy children and another group – 38 respondents with children with health difficulties. The aim of the research was to compare the assessments of the intensity of school difficulties of children in foster care in groups of respondents with or without a child with health difficulties or mental illness in their foster care. The hypothesis of a difference in assessments of school difficulties in children with/without health difficulties was formulated and statistically tested (H0: ratings of the intensity of difficulties are the same in both groups). Statistical testing of the hypothesis utilised the non-parametric Mann-Whitney test with the test results being significant at the level of significance p<0.05. Correlation was observed for each difficulty and exploratory cluster analysis shows their interrelationships. The study results according to the foster parents' assessment show a high intensity of difficulties of school-aged children in foster care in their inclusion in the classroom in establishing relationships with classmates (p-value =0.9), in a negative attitude towards learning and lack of motivation to learn (p-value =0.7) experiencing nervousness, internal tension and staying focused when learning. In addition, when comparing the groups of respondents with healthy children and children who have health difficulties/mental illness, there was a statistically significantly higher intensity of difficulties in the group of respondents with children with health difficulties when doing prep work for the classes (p-value =0.00075).

BackgroundChildren and adolescents in child welfare are characterised by a high rate of psychopathology. However, prevalence estimates vary greatly, and comparisons between studies are limited owing to different target populations,...

Back to table of contents Previous article Next article Professional NewsFull AccessJudges Endorse Principles On Foster-Care MH ServicesMark MoranMark MoranSearch for more papers by this authorPublished Online:5 Sep 2003https://doi.org/10.1176/pn.38.17.0008The national organization representing judges who preside over child foster-care placement has given its stamp of approval to a statement of principles on mental health and substance abuse services for children in foster care and their families.The statement was developed by the American Academy of Child and Adolescent Psychiatry (AACAP) and the Child Welfare League of America (CWLA), as part of an ongoing collaborative initiative to meet the mental health needs of children in the foster-care system.The initiative has grown to include more than 70 organizations, including APA.Now, the National Council of Juvenile and Family Court Judges has passed a resolution endorsing the collaboration, and the statement of principles and values, during its annual conference in San Antonio in July.The council’s resolution urges the values and principles embodied in the AACAP-CWLA statement to be used “whenever possible. . .to guide reform and innovation as we work collaboratively to improve the outcomes and well-being of these children and their families.”The council’s resolution endorses an initiative that leaders of AACAP and CWLA say is a groundbreaking effort to bring together mental health experts and the full range of people involved in foster-care placement. And it bestows on the initiative the imprimatur of pivotal decision makers in the foster-care system.“The family court judges are the arbitrators for all the decisions that get made about children and their families,” said Steve Hornberger, M.S.W., director of behavioral health at CWLA. “They preside over hearings before there is a placement and periodically throughout the child’s stay in foster care to make sure everyone is working in the interest of the child.“Nothing in foster care happens without the judges,” Hornberger added.The AACAP-CWLA initiative is an effort to address in a comprehensive way the mental health needs of approximately 570,000 children in foster care and their families.Hornberger said studies suggest that mental illness or substance abuse affects 40 percent to 85 percent of children placed in foster care, but definitive data are lacking since state agencies do not collect information on the mental health status of children or families.But he said the burden of mental illness is apparent to all who are closely involved in foster care.Systems Operate in Separate Silos“The prevalence, intensity, and severity of the mental health needs of foster children have been more than the child welfare system has been able to address,” Hornberger said. “Historically, the mental health and child welfare systems stayed separate in their silos and fragmented.”Led by AACAP President Marilyn Benoit, M.D., the initiative has grown to include more than 70 groups, meeting six times and including representatives from virtually every constituency involved in foster care.Benoit told Psychiatric News that the group is seeking funding to continue as a permanent, multidisciplinary body. “We are going to government and nongovernmental funding agencies so that we might become the first entity addressing foster care that is national in scope and broadly multidisciplinary,” she said. “We really have the leaders to form a major national constituency.”Child-Centered Perspective UrgedAn overriding theme of the values and principles developed by the collaborative group and endorsed by the Council of Family Judges is the need for a “child-centered” approach to foster-care placement and treatment for the trauma that accompanies such placement.“We think the child has been forgotten in the system,” Benoit told Psychiatric News. “It is designed to protect children, but it has become so bureaucratized and so inflexible that the child has become lost, and things get done to serve the purposes of the system, not the child.”She cited an example of a child who had been placed in the care of an aunt, who had “worked very hard to understand” and respond to the child’s needs.Later, another family member got in trouble and needed a place to stay. The aunt invited the family member in, but the added household member upset the official person-per-square-foot ratio, requiring a new placement for the child, according to the system’s regulations.“Instead of trying to work with the family, they yanked the child because there was no longer the proscribed square footage of space in the house,” Benoit said.She and other initiative leaders reported that several new documents are being prepared by work groups for a “tool kit” that can be used by “frontline staff”—the child welfare workers who first respond to a crisis situation—and others in the foster-care system.Still in draft form, the documents highlight the group’s focus on what psychiatrist Francine Cournos, M.D., called “the inner, subjective life of the child” who is invariably traumatized by the experience of placement in a strange family—even when the placement may be lifesaving.Firsthand Experience Shaped ViewsCournos, who was herself a foster child and has written about her experience in a memoir titled City of One, said the child welfare system is focused on “rescue” of the child—frequently from an abusive family situation.But that singular focus, she said, can cause social service workers and others to lose sight of the fact that the placement process itself is a frightening and traumatic experience for the child. “It is so hard to keep in mind the inner subjective experience of the child,” she said, “because from the system’s point of view the most important thing is being physically safe.”The appearance of strange people in the household and the sudden move to a strange family—in addition to the fact that many foster children may have multiple placements over a period of years—can be a terrifying, disorienting, and alienating experience.It was so for Cournos, who was not removed from her family of origin because of abuse. “I felt like a piece of furniture,” she said. Cournos is part of a work group that is developing a document specifically for the foster child, “First 30 Days Guidebook: A Guidebook for Foster Children.”The document would be presented in book form to a child at the time of placement and is intended as a kind of “memory book” wherein the child may record his or her own feelings about the experience as it happens. The book will also include questions and exercises that allow the child to record information about him or herself: favorite foods, colors, playthings, television shows.“It’s a way to help the child make sense of the experience, and something for the child to take from one placement to another,” Cournos said. “It’s also a way for the kids to communicate with their foster parents and express their needs in a systematic way.”A second document for the tool kit, also in draft form, is called “First Responder Guidelines for Initial Screening of Emergency and Urgent Mental Health/Alcohol and Other Drug-Related Issues in Children Being Removed From Their Homes.”Benoit said the guidelines will be specific, offering what amounts to a script for first responders. She notes that many of the personnel who are first responders to a crisis may be called “social workers,” but may actually have limited social-work training—so that some fundamental skills in responding to the child’s subjective experience may be lacking.“The child can have no idea what it means when strangers come into the house saying they want to take him or her to a safe place,” Benoit said. “So we have focused on the nitty-gritty, really scripting for first responders what they should say—little things like introducing oneself and explaining to the child why this is happening.”The statement on values and principles is posted on the AACAP Web site at www.aacap.org/publications/policy/collab01.htm. The “Policy Statement on Mental Health and Substance Use Screening and Assessment of Children in Foster Care” is posted at www.aacap.org/publications/policy/collab02.htm. ▪ ISSUES NewArchived

Contact between children in foster and residential care and their birth families have an impact on children’s development and on placement stability. Contact is also important for their social relationships and sense of belonging and well-being. The aim of this study was, from children’s point of view, to describe, analyse and compare contact in residential care and foster care in terms of its frequency, visit location, feelings during and after the visits, visit difficulties, happiness with their placement, their self-confidence, future perception about their lives, and perception of their subjective well-being. We used a sample of 145 children in residential care and all the children in foster care (39), aged between 11 and 15, from the same four Portuguese districts. Results indicated that children in residential care had more contact and visits with their parents than children in foster care, being phone calls the most used way to contact the children. The majority of the children presented joy or satisfaction during parents’ visits and more diffuse feelings after the visit. Also, most of children would like to have more visits and just a minority present some difficulties in their fulfilment. Nevertheless, children in foster care had more self-confidence, optimism in relation to their future, happiness in relation to their placement and higher subjective well-being than children in residential care. In summary, it seemed that the type of placement for children at risk is more important to their future than the existence of contact with their parents.

BackgroundThere is a lack of well-designed randomized controlled trials (RCTs) to investigate the efficacy of psychological therapies for children in foster care with emotional and behavioural difficulties. Mentalization-based therapy (MBT) focuses on supporting the carer-child relationship by promoting reflective capacity. This study examined the feasibility and acceptability of an RCT of MBT, delivered in a family-format, for children who are in foster care in the UK.MethodHerts and Minds was a phase II, blinded feasibility RCT with follow-up of at 12 and 24 weeks post-randomisation. Participants were children (age 5–16) in foster care referred to a targeted mental health service, who had some level of difficulty as identified by the Strengths and Difficulties Questionnaire (SDQ). Aims were to assess: the feasibility of recruitment processes and study uptake; capacity to train mental health practitioners to deliver MBT to an acceptable level of treatment integrity; establish acceptability and credibility of MBT as an intervention for children in foster care; establish feasibility and acceptability to participants of conducting an RCT; and estimate the likely treatment efficacy effect size. Participants were randomly allocated to either MBT (n = 15) or Usual Clinical Care (UCC) (n = 21) individually or in sibling groups. A range of qualitative and quantitative data was gathered to assess feasibility.ResultsFeasibility was established with regard to: capacity to recruit participants to a study; capacity to train mental health practitioners to deliver MBT to an acceptable level of treatment integrity; acceptability and credibility of MBT; and feasibility and acceptability to participants of conducting an RCT. A number of issues made it difficult to estimate a likely treatment efficacy effect size.ConclusionWith modifications, it is feasible to run an RCT of MBT for children in foster care. Both the therapy and research design were acceptable to participants, but modifications may be needed regarding both the timing of assessments and the identification of appropriate primary outcome measures. Given the lack of evidenced based therapies for this population, such a trial would be a significant contribution to the field. Findings may be useful for other groups planning clinical trials of psychological therapies for children in foster care.Trial registrationISRCTN 90349442. The trial was retrospectively registered on 6 May 2016.

Poverty, Child Maltreatment, and Foster Care

The Systematic Mistreatment of Children in the Foster Care System tells the stories of 10 children in the foster care system from diverse ethnic and cultural backgrounds and the efforts by advocates to find them permanent places to live, appropriate schooling, and other essentials they need to survive. The children’s case studies highlight the difficulties in placing and maintaining them in healthy living situations with supportive educational, mental health, and other services. The book shows how children fall-sometimes over and over again-through the "deep cracks" that exist within and between the various agencies of the multi-agency system of care that was designed to help them. Appropriate placement and services for children in foster care typically requires the coordination and collaboration of several agencies, including the juvenile court, child protective services (CPS), school districts, and departments of mental health (DMH). The Systematic Mistreatment of Children in the Foster Care System shows how these agencies frequently fail to meet their legal obligations to children in the system and what can be done to address these failures-and the outcomes they produce. The Systematic Mistreatment of Children in the Foster Care System includes: an introduction to the child protective services system the general route by which children in the United States are removed from their parents’ custody because or abuse and neglect the major components of the Individuals with Disabilities Education Act and the problems in getting foster children’s educational needs met the difficulties in securing stable out-of-home placements strategies for stabilizing home placements problems in funding for out-of-home placements strategies for advocating the removal of children from inadequate out-of-home placements legislation and practices for bringing about needed policy changes and much more Equally valuable as a professional tool and as a classroom resource, The Systematic Mistreatment of Children in the Foster Care System includes introductions to specific issues presented in each chapter; case studies that illuminate the issues presented; subsections for each case study chapter entitled "Prevention," "Intervention," "Advocacy Considerations," and "What Had Gone Wrong;" boxed items highlighting practical strategies, laws, and other relevant information; and a conclusion and summary of each chapter.

African American children are represented among those housed in foster care at more than twice the rate of their overall representation in the US population. This racial disproportionality is well known among child welfare researchers, who have been attempting to explain the phenomenon. Are African American families under more surveillance than white families because of involvement with TANF and other government aid programs, resulting in higher rates of foster care placements? Are investigators more likely to pursue allegations of abuse within African American families? Are African American children more likely to suffer from maltreatment? My research makes a unique contribution by investigating state-level variations in child welfare policy outcomes. Following the innovative work of Soss et al. (American Journal of Political Science 52(3):536–553, 2008) who find that states with larger African American populations have more stringent welfare regimes, it would be reasonable to expect that states with larger African American populations would have more aggressive child protection policies, resulting in higher numbers of children being housed in state protective custody. This work exposes a strikingly different pattern: States with larger African American populations are distinctly less likely to take children into protective custody. In addition, states with larger African American populations have dramatically lower levels of racial disproportionality among their children in foster care. States with larger white majorities place more children in foster care and place disproportionately higher percentages of African American children in foster care.

Children in foster care have complexity around medical decision-making because of their unique custody status. When medical decision-making is necessary for a child in foster care, what perspectives are important? What if opinions are not aligned? Who makes the final decision for consent? This Ethics Rounds focuses on a young child in foster care who has had repeated ear infections. Foster caregivers and family of origin are not in agreement on the treatment plan. Two experts, a foster care pediatrician and a child welfare professional, comment on the important considerations for the case, including involvement of legal representation and best interest representation in medical decision-making as well as the variability in child welfare response by state.

Linking state child care and child welfare policies and populations: Implications for children, families, and policymakers

This study explored rural foster caregivers' perceptions of telemental health (TMH) services for children in foster care in a Southeastern state. Through fourteen Zoom interviews and thematic analysis, we identified key facilitators and barriers, guided by the Unified Theory of Acceptance and Use of Technology 2 framework. Facilitators included provider engagement, ease of technology use, convenience, foster parent advocacy, reliable tech access, child willingness, cost savings, and tech familiarity. Barriers encompassed therapeutic challenges, technology issues, privacy concerns, child's lack of motivation, and policy hurdles. Addressing these multilevel factors can enhance TMH access and well-being for rural children in foster care.

Courts, child welfare agencies, and schools are all important to the achievement of safety, permanency, and well‐being for children in foster care. Although safety and permanency performance measures have been established, tested, and implemented, the development of court‐related well‐being measures have not. This article describes the initial effort to establish a set of educational well‐being measures to track success in improving educational outcomes for children in foster care.Key Points for the Family Court Community: This article provides insights to assist children in care achieve successful educational outcomes—a key to becoming self‐sufficient, productive adults. These newly developed education performance measures provide courts with a tool to measure the educational outcomes for children and youth under its jurisdiction.

Youth who have experienced foster care are at risk of negative outcomes in adulthood. The family finding model aims to promote more positive outcomes by finding and engaging relatives of children in foster care in order to provide options for legal and emotional permanency. The present study tested whether family finding, as implemented in North Carolina from 2008 through 2011, improved child welfare outcomes for youth at risk of emancipating foster care without permanency. A randomized controlled trial evaluation was carried out in nine counties in North Carolina. All children eligible for intervention services between 2008 and 2011 underwent random assignment. Effects were tested with an intent-to-treat design. Outcome data were obtained for all subjects from child welfare administrative data. Additional outcome data for a subset of older youth came from in-person interviews. Subjects included 568 children who were in foster care, were 10-17 years old (at time of referral), had no identified permanent placement resource, and had no plan for reunification. The confirmatory outcome was moves to more family-like placements, whether through a step-down in foster care placement or discharge from foster care to legal permanency. No impact on the confirmatory outcome was observed. Findings regarding exploratory impacts are also described; these must be interpreted with caution, given the large number of outcomes compared. The evaluation failed to find evidence that family finding improves the outcomes of older youth at risk of emancipation from foster care.

All children require a safe and nurturing environment for optimal development. Child maltreatment is among the most serious societal problems, with severe behavioral, health, and economic costs. Preventing and responding to child maltreatment is therefore among the most critical services a society can provide. Child protection in the United States is handled by many agencies in a general sense, including law enforcement and health departments. The main agency tasked with protecting children is the Child Protective Services (CPS) system, which is charged with supporting the safety and well-being of children who may be at risk of child maltreatment. Child maltreatment is a common societal problem, with various national studies suggesting that up to a third of children may experience maltreatment before turning 18. CPS contacts about 4% of all children in the United States each year. Among children contacted, about one fifth are substantiated and a very small proportion of all children reported are placed in foster care. CPS serves poor persons at higher rates than wealthier persons, consistent with the higher need for protection faced by those under economic stress. Similarly, Black children are contacted by CPS at a rate almost twice that of White children, consistent with increased risks and stressors faced by that population, largely associated with historical and current racism, particularly as manifested in economic racial stratification. Child welfare practice innovations include, among other things, the increased use of “differential response” programs, in which situations presenting fewer safety risks are handled with less emphasis on investigation, and an increased awareness of the need for preventative services, including services aimed at supporting those under severe economic stress.

Economic conditions and the number of children in foster care