Mentoring Relationship Quality and Maltreated Children's Coping.

Supportive Relationships Among Youth and Non-parental Adult Relatives

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.

We examined the impact of the implementation of The Triple P-Positive Parenting Program in North Carolina (NC) on reducing child maltreatment, a serious public health problem in the US with lasting harmful effects on children. In 2012 and 2013, 34 of 100 counties in NC implemented Triple P. A panel data set with county-level child welfare data and emergency department (ED) discharge data from 2008 to 2015 for 100 counties in NC was constructed. A quasi-experimental design using difference-in-differences analysis estimated the association between the implementation of Triple P and the rate of (1) investigated child maltreatment reports; (2) entry into foster care; and (3) ED visits concerning for child maltreatment. Implementation of Triple P was associated with in a 4% decrease in the county rate of investigated reports of child maltreatment (RR = 0.96, 95% CI [0.93, 0.99]) and a 7% decrease in the county rate of children in foster care (RR = 0.93, 95% CI [0.88, 0.98]). Each of these findings was robust to one but not both sensitivity tests performed. There was no reduction in county-level rates of ED visits with ICD-9-CM codes concerning for child maltreatment. Implementation of Triple P in NC outside of the parameters of scientific study is associated with small reductions in the rates of child maltreatment reports and foster care placements. Additional research is needed to understand whether such small reductions justify the substantial investment communities are making in Triple P.

The presence of caring adults in the extended family and unrelated adults, such as neighbors, teachers, youth workers, and clergy, is thought to make a positive contribution to young adolescent development. Many reports mention the importance of those relationships, but there is a sparse empirical literature describing their nature and role in young adolescents' lives. The available literature is reviewed here with respect to (a) identifying the nonparental adults who positively affect adolescents; (b) characterizing the kinds and frequency of contact between adolescents and nonparental adults; and (c) articulating the functions that the relationship serves and specifying the personal characteristics of the nonparental adult. Specifically addressed in this article are the ways in which age and grade, gender ethnicity, and socioeconomic status of the adolescent, and the characteristics of the community, affect adolescents' relationships with nonparental adults.

Economic conditions and the number of children in foster care

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

To examine the impact of a mentoring and skills group intervention for preadolescent children in foster care on placement stability and permanence at 1-year postintervention. A randomized controlled trial was conducted with 9- to 11-year-old children who were maltreated and placed in foster care (n = 54 control; n = 56 intervention). State child welfare records provided information on number of placement changes, placement in residential treatment, and case closure (ie, permanency). Rates of adoption and reunification were also examined. Analysis was by intention to treat. After controlling for baseline functioning and preintervention placement history, intervention youth were 71% less likely to be placed in residential treatment (odds ratio [OR] = 0.29, 95% confidence interval [CI] 0.09-0.98). There were no significant treatment differences in predicting placement changes or permanency for the total sample. Among a subsample of children living in nonrelative foster care at baseline, intervention youth had 44% fewer placement changes (incidence ratio = 0.56, 95% CI 0.34-0.93), were 82% less likely to be placed in a residential treatment center (OR = 0.18, 95% CI 0.03-0.96), and were 5 times more likely to have attained permanency at 1 year postintervention (OR = 5.14, 95% CI 1.55-17.07). More intervention youth had reunified 1-year postintervention [χ(2)(1, N = 78) = 3.99; P < .05], and the pattern of findings suggested that intervention youth had higher rates of adoption. A significant interaction [χ(2)(1, N = 110) = 5.43; P = .02] demonstrated that the intervention attenuated the impact of baseline behavior problems on placement changes. The findings suggest that participation in a 9-month mentoring and skills group intervention leads to greater placement stability and permanence, especially for children in nonrelative foster care.

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.

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&lt;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).

Maternal relationship characteristics have been found to impact academic and behavioral outcomes for youth. However, less is known about how and through what mechanisms these characteristics impact outcomes for mentored youth. In this study, we examined if mentoring relationship quality mediated the relations between maternal relationship characteristics and academic and behavioral outcomes targeted by mentoring programs. Data were drawn from 205 participants who participated in a mentoring program that pairs adolescent girls with college women mentors for 1 year of mentoring. Mentoring relationship quality was the hypothesized mechanism of change and was included in the analysis as a mediator. Results revealed that maternal relationship characteristics (i.e., maternal quality communication/trust and maternal alienation) were directly related to academic and behavioral outcomes of mentoring. The relationship between maternal relationship characteristics and behavioral outcomes was mediated by mentoring relationship quality. Results suggested that girls with stronger maternal quality communication and trust as well as girls who felt more alienated from their mothers may benefit more from mentoring. Results can be used to inform mentor training to include a focus on relationship development with girls experiencing a variety of relational difficulties with their mothers to help improve targeted mentoring outcomes.

Poverty, Child Maltreatment, and Foster Care

* Abbreviation: CSHCN — : children with special health care needs An estimated 428 000 children are in foster care in the United States1; half of those children experience chronic medical problems and unmet health care needs.2 These ∼200 000 children span a spectrum from low to high health care needs and utilization,2 with the most complex having frequent hospitalizations and significant home care burdens.3 These children with medical complexity have multisystem, long-term diseases, and/or functional limitations that result in high care needs, high health care utilization, and often rely on medical technology.4 Although the majority of children enter foster care because of neglect or abuse, sometimes a child with medical complexity will enter foster care because his or her daily care needs outstrip their families’ resources or capabilities.1 They are often placed in medical foster care with foster parents who receive medical training, reimbursement at higher rates than typical foster parents, and special services (eg, respite, support groups) to match the needs of the medically complex foster child. Children with medical complexity account for one-third of all pediatric health care spending and expectedly have some of the most expensive care needs among children in foster care.5,6 Medical foster care is typically the most expensive foster placement in terms of daily rates provided to foster parents, although payment incentives have not increased the number of medical foster parents to meet the current demand.7 Not much is known about the outcomes of children in medical foster care or about the value of the federal and state resources dedicated to this population. Most available … Address correspondence to Renee D. Boss, MD, MHS, Department of Pediatrics, Johns Hopkins University School of Medicine, Berman Institute of Bioethics, 1809 Ashland Ave, Baltimore, MD 21287. E-mail: rboss1{at}jhmi.edu

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.

Interstate variation in trends of psychotropic medication use among Medicaid-enrolled children in foster care