Language Matters: Identifying Medically Complex Children in Foster Care.

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).

Effects of formal center-based care and positive parenting practices on children in foster care

Economic conditions and the number of children in foster care

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.

A unique feature of some Africans who come to study and work in Britain is the practice of making private arrangements to send their children to live with foster parents who assume full parental rights. Six hundred randomly selected African families, with a child born between June 1988 and May 1991, resident in one Health Authority, were sent a questionnaire to elicit the proportion of children who had been in private foster care and to gain information on the knowledge and attitudes to fostering and day care provision. Families with children in foster care were asked additional questions about their experiences. Two hundred and six (34%) of the questionnaires were analysed. Seventy-six per cent of the respondents were from Nigeria, 65% had already heard about private fostering and 29 (14%) had sent one of their children to private foster care. Only one family felt that foster care was a suitable option; the reminder would have preferred alternative facilities such as nursery placement. Of the 29 children in foster care, nine parents said their children were unhappy and five rated the foster parents as bad. Contrary to popular belief, most children were visited fortnightly, some more frequently and only two never visited. Private fostering in this group of children was found to be less common than in earlier studies.

Mental health needs and therapeutic service utilization of young children in foster care in Germany

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.

Informal foster care practice in Anambra State, Nigeria and safety concerns

Foster care is a form of care for children who can’t receive appropriate care in their primary family. It’s an alternative to institutional care for children and its advantage is the family environment. The aim of this research was to gain an insight into experiences of Roma foster parents (N = 7) with providing foster care in Roma settlements. The results of this research show that Roma foster parents decided to become foster care providers because of their desire to provide an appropriate care for children, the existence of conditions for providing foster care and their experience with foster care through life. Hindering factors in providing foster care are the reactions of local people, behaviour of the biological parents of children, children’s behaviour and life in the Roma settlement due to their specific way of life. Empowering factors in providing foster care are: social support, so-called emotional “effects” of foster care on the foster parents as well as life in the Roma settlement due to preservation of the culture, language and identity. Practical implication of the research is a deeper understanding of this subject area, and the results, besides being used to consider future research, also provide guidelines for practical action for improving the quality of care for Roma children in foster care and supporting Roma foster parents in accordance with their tradition and culture.

The paper reports epidemiological and phenomenological investigations of aberrant eating among 347 pre-adolescent children in court-ordered foster and kinship care, in New South Wales, Australia. A quarter of children displayed clinically significant aberrant eating problems, with no evidence of gender or age effects. Two distinct patterns were identified. The first is a pattern of excessive eating and food acquisition and maintenance behaviors without concurrent obesity (termed Food maintenance syndrome), resembling the behavioral correlates of Hyperphagic Short Stature (Psychosocial Dwarfism). Various data suggest this pattern is primarily triggered by acute stress, including maltreatment in care, against a background of complex psychopathology and developmental disabilities. The second is a cluster of pica-type eating behaviors that correlates with self-injurious behavior, and is closely associated with developmental disabilities. The paper includes recommendations for clinicians working with pre-adolescent children in care.

Chapter 10 broadly focuses on foster parents’ mental well-being and reveals the impact that caring for children can have on foster parents. It explains that promoting foster parents’ well-being can improve their retention and ability to care for children, thus directly tied to the well-being of children in care. The chapter describes how foster parents, social workers, and other professionals may experience secondary trauma and vicarious trauma through their work with children in foster care. It outlines the grief and loss foster parents can experience as children leave their homes, even when the foster parents are supporting the reunification or the placement change. The text includes information about disenfranchised grief and ambiguous loss that foster parents can experience. The chapter argues for the need for self-care and instructs social workers to encourage and normalize self-care practices.

Compliance and Internalization in Preschool Foster Children

Attachment theory is pivotal to understanding children in a foster care. Foster care by definition disrupts attachment relationships and insecure attachment relationships may be threatened further. Very few children in foster care are securely attached to their biological parents, and the security of the attachment relationship with foster parents predicts outcomes for the child. Children are thought to develop mental representations or ideas about relationships through the quality of their attachment relationships. Assisting foster parents to develop nurturing relationships and the conditions necessary to develop attachment security is vital. This chapter discusses attachment styles, especially disorganised attachment, the development of the child’s internal working model of relationships and the findings of attachment research in foster care.

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

Behavioral and emotional problems have been observed in emotionally vulnerable children in foster care under certain circumstances. A common pattern involves the unpredictable appearance of a previously absent or unavailable natural parent. Such an occurrence precipitates the reawakening of the child's ambivalent feelings toward both natural and foster parents as well as their fears of abandonment. This frequently leads to behavior that is oppositional and difficult to manage. If the foster parents find the child's behavior unmanageable, and if they are not provided with appropriate professional support during this difficult period, a crisis often follows that precipitates the child's removal from the foster home. Individual, familial, and systemic contributions to this dilemma are discussed. This article emphasizes the origins and nature of the intrapsychic dilemma faced by these children. Particular emphasis is placed on the manifestations of a conflict of loyalty, in the child, and its relationship to the oppositional behavior of these children in foster care. Additional considerations include the impact of inconsistent parenting, abuse and neglect by the natural parents, the assumption of a parental role by the child and a concomitant renunciation of the child's dependency needs, as well as an examination of the role of the foster parent's fantasy of what it will be like to parent a traumatized child.