Safety and stability for foster children: the policy context

Even though federal laws have had a major influence on foster care and child welfare policy for more than 40 years, additional reforms are needed to ensure safe and stable families for children in care. This article describes the complex array of policies that shape federal foster care and observes: A number of federal policies addressing issues such as housing, health care, welfare, social security benefits, taxes, and foster care reimbursement to the states, form the federal foster care policy framework. The Adoption and Safe Families Act significantly altered federal foster care policy by instituting key changes such as defining when it is reasonable to pursue family reunification, expediting timelines for making permanency decisions, recognizing kinship care as a permanency option, and providing incentives to the state for increasing the number of adoptions. Courts play a key and often overlooked role in achieving safety and permanency for children in foster care. Efforts to improve court performance have focused on increasing the responsiveness and capacity of courts. The article concludes with policy recommendations that are needed to improve the lives of children in foster care, such as increasing investments in children and families, redirecting funding incentives, addressing service gaps, and enhancing accountability.     

Addressing the developmental and mental health needs of young children in foster care

Research over the past two decades has consistently documented the high rates of young children entering the child protective services/child welfare system with developmental and mental health problems. There is an emerging evidence base for the role of early intervention services in improving outcomes for children with developmental and mental health problems in the general population that heavily relies on accurate and appropriate screening and assessment practices. The Child Welfare League of America, the American Academy of Pediatrics, and the American Academy of Child and Adolescent Psychiatry have all published guidelines concerning the importance of comprehensive assessments and appropriate referral to early intervention services for children entering out-of-home care. Recent federal legislation (P.L. 108-36) calls for increased collaboration between child welfare and public agencies to address the developmental and mental health needs of young children in foster care. This paper provides a framework for health, developmental, and mental health professionals seeking to partner with child welfare to develop and implement programs addressing these critical issues.     

The experience of foster care: relationship between foster parent disciplinary approaches and aggression in a sample of young foster children

The relationship between disciplinary practices of 70 foster parents (kin and nonkin) and aggression in their 8-year-old foster children was examined. Aggressive behavior was assessed through child and foster parent reports, whereas disciplinary behavior was examined by asking foster parents how they would typically respond to five child misbehaviors. Kinship foster parents (64.8%) were significantly more likely than nonkinship foster parents (30.2%) to report that they would use harsh discipline (p < .01). No significant relationship was found between foster parent reports of child aggression and their reports of disciplinary behavior. However, foster parents who reported they would use harsher discipline were more likely to have children in their care who generated multiple aggressive solutions to social problems (odds ratio = 2.7, p < .01). The evidence suggesting that the disciplinary practices of foster parents may influence children's social aggression is discussed in relation to future research, policy, and interventions.     

Clinic-day surgery for children: a patient and staff perspective

Introduction

For the past 3 years, our institution has implemented a same clinic-day surgery (CDS) program, where common surgical procedures are performed the same day as the initial clinic evaluation. We sought to evaluate the patient and faculty/staff satisfaction following the implementation of this program.

Methods

After IRB approval, patients presenting for the CDS between 2014 and 2017 were retrospectively reviewed. Of these, patient families who received CDS were contacted to perform a telephone survey focusing on their overall satisfaction and to obtain feedback. In addition, feedback from faculty/staff members directly involved in the program was obtained to determine barriers and satisfaction with the program.

Results

Twenty-nine patients received CDS, with the most commonly performed procedures being inguinal hernia repair (34%) and umbilical hernia repair (24%). Twenty (69%) patients agreed to perform the telephone survey. Parents were overall satisfied with the CDS program, agreeing that the instructions were easy to understand. Overall, 79% of parents indicated that it decreased overall stress/anxiety, with 75% saying it allowed for less time away from work, and 95% agreeing to pursue CDS again if offered. The most common negative feedback was an unspecified operative start time (15%). While faculty/staff members agreed the program was patient-centered, there were concerns over low enrollment and surgeon continuity, because there were different evaluating and operating surgeons.

Conclusion

This study successfully evaluated the satisfaction of patients and faculty/staff members after implementing a clinic-day surgery program. Our results demonstrated improved patient family satisfaction, with families reporting decreased anxiety and less time away from work. Despite this, faculty and staff members reported challenges with enrollment and surgeon continuity.

     

Ultrasound for screening developmental dysplasia of the hip: a European perspective

PURPOSE OF REVIEW: For the past 20 years, sonography of the hip has become the imaging procedure of choice to diagnose hip maturation disorders in German-speaking countries. In Austria, hip sonography is a mandatory and essential feature of preventive public health measures; the "Mutter-Kind-Pass" has been the official medical identity card for mother and child since 1992 in Austria. This review summarizes the most recent literature dealing with ultrasound screening for developmental dysplasia of the hip in Europe. RECENT FINDINGS: This article focuses on the results in recent articles about sonography screening of the hip joint in the first year of life. SUMMARY: The continued development and refinement of the method, which is now standardized in German-speaking countries and hence can be taught in uniformly structured courses, has made sonography of the infant hip a gold standard for screening for developmental dysplasia of the hip in these countries.     

The foster care clinic: a community program to identify treatment needs of children in foster care

A community-based multiagency and multidisciplinary clinic was developed to perform comprehensive evaluations of preschool children in foster care. One hundred thirteen children, ages 1 month to 6 years old, were seen during the first 2 years. Forty-seven percent of the children were known to the social service agency from birth; however, the mean age at placement was 19 months. Fifty-seven percent of the children were in their first foster home at the time of their initial evaluation, but 17% has already been placed in three or more homes. Behavioral problems were found in 39% of the children, and chronic medical problems in 35%. Sixty-one percent of the children were delayed in one or more portions of the developmental assessment. Developmental delay was associated with older age. Sixty percent of the children with developmental delays were not involved in any community educational or therapeutic program, although they had been in foster care for a mean of 6 months. Because of the high mobility of this population, continuity of care by social workers, foster parents, and physicians is hard to achieve. The evaluation model developed by the clinic appears to facilitate the identification of children in need of additional services, enhances cooperation between various community agencies, and provides a constant site for monitoring the status and progress of children in foster care.     

Sleeping through the night: a developmental perspective.

This study examines falling asleep and night waking in human infants during the first 8 months of life. All-night time-lapse video recordings were obtained at 3 weeks and 3 months of age; a Sleep Habits Interview was completed at these ages and repeated at 8 months of age by telephone interview. At the 3-week and 3-month ages, self-report measures of maternal psychologic distress, depression, and self-esteem were also obtained. The data are examined from both cross-sectional (age group) and longitudinal (individual) perspectives. Parent-infant interactions at bedtime and during the middle of the night changed significantly with increasing age. At 3 weeks of age, most infants were put into their cribs for the night already asleep. When they awakened in the middle of the night, they were removed from their cribs. By the time they returned to their cribs, they were again asleep. By 3 months of age, infants who were put into the crib awake at bedtime and allowed to fall asleep on their own were more likely to return to sleep on their own after awakenings later in the night. In contrast, infants who were put into the crib already asleep at the beginning of the night were significantly more likely to be removed from the crib following a subsequent nighttime awakening. Thus, the pattern of bedtime sleep onset was related to sleep onset following an awakening in the middle of the night. This association was present at 8 months as well.(ABSTRACT TRUNCATED AT 250 WORDS)     

Emotional and behavioural difficulties in young children with and without developmental delay: a bi‐national perspective

Background: Relatively high rates of emotional and behavioural difficulties have been reported among children with intellectual or developmental disabilities. Little is known about nature of the relationship between cognitive development and psychopathology in very young children. Methods: Secondary analysis of data from the first two waves of the UK’s Millennium Cohort Study (n = 11,389) and the first two waves of the Longitudinal Study of Australian Children (n = 4,606). Results: Two‐ to three‐year‐ old children with developmental delay show significantly higher rates of emotional and behavioural difficulties than their peers. These differences appear to reflect a general association between cognitive performance and emotional/behavioural difficulties in the bottom half of the ability spectrum and threshold‐based discontinuities within the bottom 3% of the distribution. In the UK, but to a much lesser extent in Australia, higher rates of emotional and behavioural difficulties among children with developmental delay may be partially attributed to greater risk of exposure to adverse socio‐economic circumstances. Conclusions: The results highlight the potential value of targeted preventative interventions for young children with developmental delay.     

Health services for California's foster children: current practices and policy recommendations

The organization and delivery of health services to children in foster care was investigated in 14 California counties in 1985. Foster care administrators, child welfare workers, foster parents, and health care providers responded to questionnaires and structured interviews performed by two pediatricians knowledgeable about the child welfare system. The organization of health services demonstrated a high degree of variability between counties. Although some counties initially evaluate all dependent children using specific protocols and examinations sites, more often services were poorly organized, fragmented, and had few safeguards to ensure delivery of appropriate health care. Use of recommended Early Periodic Screening Diagnosis and Treatment services was also variable, and counties could not provide documentation of use rates by foster children. Even less consistent was the performance of routine initial mental health assessments. Financial disincentives, fewer available providers, difficulties in obtaining and using Medicaid-reimbursed services, and fragmentation of services were frequently identified as barriers to access. To improve the organization and delivery of services, access barriers must be diminished, services must be better organized and integrated, and new financing mechanisms must be developed. Specific policy recommendations are presented.     

Effects of a foster parent training intervention on placement changes of children in foster care

Placement disruptions undermine efforts of child welfare agencies to promote safety, permanency, and child well-being. Child behavior problems significantly contribute to placement changes. The aims of this investigation were to examine the impact of a foster parent training and support intervention (KEEP) on placement changes and to determine whether the intervention mitigates placement disruption risks associated with children's placement histories. The sample included 700 families with children between ages 5 and 12 years, from a variety of ethnic backgrounds. Families were randomly assigned to the intervention or control condition. The number of prior placements was predictive of negative exits from current foster placements. The intervention increased chances of a positive exit (e.g., parent/child reunification) and mitigated the risk-enhancing effect of a history of multiple placements. Incorporating intervention approaches based on a parent management training model into child welfare services may improve placement outcomes for children in foster care.