Health Risk Behavior of Youth in Foster Care

PROBLEM:    Many adolescent health problems are predominantly caused by risk behavior. Foster adolescents have disproportionately poor health; therefore, identification of risk behavior is critical.
METHOD:    Data from a larger study were analyzed to investigate the health risk behavior of 56 youth in foster care using the Child Health and Illness Profile–Adolescent Edition.
FINDINGS:    Data indicated that youth in foster care had some increased risk behavior when compared with a normative adolescent population. Younger adolescents and those in relative placement had less risky behavior. Risk behavior was increased for youth in foster care when they were in group homes, had experienced a parental death, or had a history of physical or emotional abuse or attempted suicide.
CONCLUSIONS:    These results point to areas of strength and vulnerability for youth in foster care and suggest areas for clinicians and caregivers of these adolescents to focus interventions towards harm reduction and enhancement of resiliency.     

Family Involvement in Treatment Foster Care

Child mental health policy and practice has increasingly embraced family-driven practice which promotes family involvement in all aspects of planning and service delivery. While evidence for positive outcomes related to family involvement is mounting in traditional residential treatment, there is little information about family involvement in treatment foster care. This study provides data on family involvement in a statewide randomized trial of treatment foster care. The types of family involvement, factors associated with such involvement, and placement outcomes were examined. Nearly 80% of youth experienced recent family contact and/or family participation in treatment planning. Implications for research, policy, and practice to increase understanding the role of family involvement are discussed.     

Developmental Health of Infants and Children Subsequent to Foster Care

BACKGROUND: Every day, the United States child welfare system is entrusted with the care of over 400,000 children through foster care. The majority of children entering this social setting are infants, the most developmentally vulnerable. METHODS: Bronfenbrenner's human health ecology model and Bowlby's attachment theory are used to delineate the social setting of foster care and its impact on developmental health, and elucidates the relationship between childhood experiences and the overall continuum of health. Additionally, the notion of inherited genes and environmental influences or epigenetics toward gene expression will be explored. RESULTS: Research points out that what happens in childhood matters; the consequences of not addressing childhood adversity and the associated risk factors of foster care increase a child's risk for poor developmental health and other major illnesses noted later in life such as cardiac disease, depression, and even premature death. Healthcare providers and others charged with caring for this vulnerable population who understand the social setting of foster care and its impact on developmental health may help identify and treat developmental problems earlier, thus potentially reducing long-term effects of abuse and neglect. CONCLUSION: Improvement plans that promote best practice for child welfare must include those that directly address the unique developmental needs of all infants and children in foster care itself. Such plans will ensure that foster care as an intervention to protect vulnerable children at risk does not create more harm by reducing the associated risks and maximizing benefits while in foster care, and ensures that those born genetically vulnerable and disproportionately susceptible to poor outcomes in adversity are also protected and provided opportunities that promote optimal developmental health.     

Children in Foster Care: A Nursing Perspective on Research, Policy, and Child Health Issues

ISSUES AND PURPOSE. To examine the roles of public policy and poverty on the rising number of children in family foster care, and to examine the impact of different types of family foster care on children's well-being.
CONCLUSIONS. Recent changes in welfare legislation increase the likelihood of family poverty, with a subsequent increase in the number of children in out-of-home care. Greater emphasis needs to be placed on preventing entry into out-of-home care, improving the quality of foster care, and giving children a voice in care decisions.
PRACTICE IMPLICATIONS. Nurses have important roles to play in the prevention of family dissolution, the design of healthcare delivery systems for children in foster care, in evaluating and educating all types of foster families, and as advocates in legal and legislative proceedings.     

Residential Treatment of Substance Abusing Adolescents: Trends in the Post-Managed Care Era

ABSTRACT

This paper explores historical and recent trends in the delivery of residential adolescent substance abuse treatment, looking specifically at the impact of managed care on the service delivery system. Three historical eras are conceptualized by the authors: (1) an era prior to managed care in which services were provided on a fee for service basis by health insurance companies and lengths of stay were relatively longer; (2) an era of managed care in which services were funded through managed care organizations and lengths of stay were significantly reduced; and (3) the current era in which residential services are provided through self-pay and through other service systems. Awareness of these changes is important for all practitioners who provide services to adolescents and demonstrate the need to advocates for residential substance abuse services for all adolescents.     

The Impact of Transitional Housing on the Post-Discharge Functioning of Former Foster Youth

Three years of data that describes the adaptation of 106 former foster youth to young adulthood are presented. Youth outcomes were compared on whether they initially resided in transitional housing (TH) at discharge or went to other living arrangements (OLA). Findings were that youth residing in the TH reported more housing stability, were less likely to be unemployed, used substances less, and had less criminal justice contact than OLA youth. However, multivariate analysis showed substance users and Caucasian youth had more housing instability than others, regardless of their initial discharge housing arrangement. The implications of these findings are discussed.     

Children in foster care: a vulnerable population at risk.

TOPIC: Nationally, 542,000 children are in foster care. Many of these children have prior histories of maltreatment such as abuse and neglect, with neglect being the most common form of maltreatment and the reason for many children requiring foster care services. Painful experiences associated with maltreatment and the trauma of being removed from one's parents (foster care) may affect the developmental and mental health of children. PURPOSE: This paper synthesizes the experiences associated with foster care and reveals foster care outcomes obtained through a literature search of published research. Specifically, the notions of oppression and domination defined by Young (1990) experienced by children in foster are explored. SOURCES: Review of the literature and clinical practice. CONCLUSIONS: Most children in foster care, if not all, experience feelings of confusion, fear, apprehension of the unknown, loss, sadness, anxiety, and stress. Such feelings and experiences must be addressed and treated early to prevent or decrease poor developmental and mental health outcomes that ultimately affect a child's educational experience and the quality of adulthood. Systemic orientation for all children entering foster care is proposed as a preventative intervention that addresses associated experiences of children in foster care.     

Older Youth Nearing Their Exit from Congregate Care: Current Innovative Programs

The present paper reviews literature on older youth in foster care with a focus on those older youths in residential. We aim to examine what has been written in the scholarly literature about this specific group. Literature was reviewed from the last decade on the problems these youths face and potential solutions for them in the program literature. A literature review was done utilizing keywords. Further, this paper presents highlights from two informational interviews with residential agencies. Here we aim to describe what the Executive Directors and staff members believe older youths need, how they work with them and the important components of a residential facility for older youth. Findings uncovered that both agencies highlighted the importance of pro-social attachments, or caring relationships, along with education and safety. Also, the critical importance of preparing youths enough so that when they leave residential they will have reduced the gap between their skills and others their age, so as to be able to compete in society for jobs and further education. Limitations include lack of generalizability, among others.     

Children in Residential Group Care With No Family Ties: Facing Existential Aloneness

The issue of children living in residential group care in Israel completely without family ties is studied in order to explore the feelings of staff and uncover possible characteristics of these children. Data were collected through focus groups, questionnaires, and life stories of children who left group care at 18 years of age. Results reveal that the children's aloneness is central in their lives and arouses painful and powerful emotions that staff members tend to avoid. Facing the future alone without support and guidance led to major crisis during adolescence. Those who had formed a long-term, significant relationship with an adult fared better.