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A paradigm shift in responding to children who have experienced trauma: The Australian treatment and care for kids program
Abstract
There is now considerable evidence to suggest that children placed in foster care experience greater levels of adversity compared to those in the general population. Early adversity has been shown to continue across the lifespan: those who have experienced the sustained trauma of threat or deprivation have a range of poor life outcomes including homelessness, poor mental health, and over-representation in the criminal justice system and low educational attainment.
This paper reports on a study of a program response to children who have experienced trauma and are placed in out-of-home care. The program model, known as Treatment and Care for Kids (TrACK), introduced a paradigm shift in the treatment and care of children in Australia, in that it was designed to provide intensive, home-based therapeutic intervention for children presenting with complex trauma and challenging behaviours. This program sought to integrate knowledge about the neurobiology of trauma with therapeutic practice and care, reflecting growing recognition that ‘care is not enough’ to achieve holistic and effective healing for children who have experienced severe trauma. As such, the relationship that encircles the child was seen as the vehicle for recovery.
The study examined client files and interviewed carers, key professionals and young people who had experienced the therapeutic care program since its inception 18 years ago. Data, informed by narrative inquiry methodology, were analysed. Key findings highlight the significance of relational practice to interrupt the projected trauma trajectory and for young people to stabilise and self-regulate.
... In addition, compared to other young people in Norway, they are often more inactive in education or working life as adults [28]. International studies have shown that residents often have mental illnesses, intellectual or learning difficulties, challenging behaviours [29][30][31], substance misuse and/or self-harming issues [32]. The dominant narratives of young people in residential care are about individuals' psychological struggles. ...
... A longitudinal study from 1981-1998 included 25 girls and young women (12-16 years old) who had multiple problems, such as being without a permanent place to live and having a history of criminality, drug abuse and significant difficulties adapting to school and home [36]. The dominant stories based on these studies circulate narratives of young people who have several psychological, substance abuse and behavioural problems [30][31][32][33][34][35][36]. Less attention has been paid to young women's resistance to these "big stories" and how they narrate experiences of being children at risk who have become young adults managing everyday life. ...
Abstract
Interdisciplinary social work practice produces and circulates narratives of young women in residential care. The dominant narratives often present negative descriptions of this group, and less attention has been paid to their resistance to these “big stories”. This study’s aim is to illuminate this resistance of young women in residential care and to explore how they narrate their experiences of being children at risk who have become women managing everyday life. This study utilises a narrative approach and includes three selected personal stories: two from the participants and one from the first author’s reflections on resistance. Through contextual analysis at the macro, meso and micro levels, we focus on how personal stories can influence interdisciplinary social work services. We found resistance to dominant narratives on the different levels in the chosen stories. Resistance can create space to reconstruct and renarrate reality together and help understand the meaning and power of storytelling and silence. Participants’ resistance can be a tool to rebalance the power between social work practitioners and service users. Based on this analysis, we suggest that interdisciplinary collaborative social work should emphasise service users’ personal stories to a higher degree and, in this way, increase user participation in residential care.
... In addition, compared to other young people in Norway, they are often more inactive in education or working life as adults [28]. International studies have shown that residents often have mental illnesses, intellectual or learning difficulties, challenging behaviours [29][30][31], substance misuse and/or self-harming issues [32]. The dominant narratives of young people in residential care are about individuals' psychological struggles. ...
... A longitudinal study from 1981-1998 included 25 girls and young women (12-16 years old) who had multiple problems, such as being without a permanent place to live and having a history of criminality, drug abuse and significant difficulties adapting to school and home [36]. The dominant stories based on these studies circulate narratives of young people who have several psychological, substance abuse and behavioural problems [30][31][32][33][34][35][36]. Less attention has been paid to young women's resistance to these "big stories" and how they narrate experiences of being children at risk who have become young adults managing everyday life. ...
Interdisciplinary social work practice produces and circulates narratives of young women in residential care. The dominant narratives often present negative descriptions of this group, and less attention has been paid to their resistance to these “big stories”. This study’s aim is to illuminate this resistance of young women in residential care and to explore how they narrate their experiences of being children at risk who have become women managing everyday life. This study utilises a narrative approach and includes three selected personal stories: two from the participants and one from the first author’s reflections on resistance. Through contextual analysis at the macro, meso and micro levels, we focus on how personal stories can influence interdisciplinary social work services. We found resistance to dominant narratives on the different levels in the chosen stories. Resistance can create space to reconstruct and renarrate reality together and help understand the meaning and power of storytelling and silence. Participants’ resistance can be a tool to rebalance the power between social work practitioners and service users. Based on this analysis, we suggest that interdisciplinary collaborative social work should emphasise service users’ personal stories to a higher degree and, in this way, increase user participation in residential care.
... We have identified three models of care and service delivery for young people in OoHC in an Australian context which have been explored in the literature. Turnaround (Wyles, 2007)a Wraparound adaption in the Australian Capital Territory, Evolve Therapeutic Services (Klag et al., 2016;Eadie, 2017) another Wraparound model evaluated in Queensland, and TrACK (Treatment and Care for Kids; McPherson et al., 2018) in Victoria. All report promising results when evaluated with young people in OoHC, with the common factors of these models expanded on below. ...
Young people in Out of Home Care (OoHC) have complex mental health and psychosocial needs due to a range of individual, systemic and intergenerational factors that may limit the effectiveness of usual clinic-based services. To address this, in 2017 an assertive-integrated service (AIS) model of care was adopted by the Child and Adolescent Mental Health Service (CAMHS) in South Western Sydney Local Health District (SWSLHD), Australia, through outreach to the young person in the community. This paper outlines the study protocol comparing AIS with clinic-based CAMHS usual care to meet the physical, mental health and wellbeing needs of young people in OoHC. Using routinely collected outcome data, the AIS model will be compared to clinic-based CAMHS treatment as usual care. Measures of overall functioning (e.g. Global Assessment Scale [CGAS]), psychological functioning (e.g. Strength and Difficulties Questionnaire [SDQ]), general health and social functioning (e.g. Health of the Nation Outcome Scales for Children and Adolescents [HoNOSCA]) and other relevant socio-demographic and clinical variables will be collected at intake and at 3-month intervals until discharge from the respective services. Semi-structured interviews will also be conducted with young people, their carers, and service providers, to examine qualitative themes about the suitability of service provision. It is expected that a better understanding of the key indicators of functioning for young people accessing AIS and clinic-based services will help inform what works for these young people so that they can receive targeted and tailored support from the start of service engagement.
... Evidence suggests that young people in out-of-home care often come from troubled family backgrounds, where a safe and secure base is absent (Beek & Schofield, 2004). They manifest complex needs, which are underpinned by histories of the trauma of abuse, abandonment, neglect and deprivation McPherson et al., 2018). Because experiences of child abuse and neglect are intersectional and informed by variables such as age, race, gender, disability and sexual orientation, queer youth in care are likely to have additional trauma history or challenges due to their minority sexual orientation and gender identities (Schofield et al., 2019). ...
Young people who are placed in out-of-home care are amongst the most vulnerable in our community. Removed from or rejected by their families, they must learn to live with carers who may be strangers. They may have experienced the trauma of abuse or neglect. Post care, they may experience further social isolation and marginalisation due to limited social capital. These challenges are compounded for queer young people placed in out-of-home care. This study adopted a case study approach to explore the lived experience of two young adults growing up queer in and out of out-of-home care in Australia. Our investigation was framed by two complementary theoretical frameworks. The first, a model of minority stress, is informed by queer perspectives and enabled an exploration into the adverse impact of enduring stigma and prejudice associated with homophobia and transphobia on young people’s capacity to thrive. The model of social capital was then employed to inform an analysis of relationships between queer young people in out-of-home care and trustworthy adults. The findings suggest that queer young people growing up in out-of-home care experience minoritised stress, with lasting negative implications. The presence however, of trustworthy adults who challenge dominant heteronormative assumptions and work to support queer young people can be experienced as stabilising and restorative.
... Supportive foster parents can help children cope with the effects of their adverse experiences by building a positive relationship with their foster child (Smyke & Breidenstine, 2019). Foster parents' efforts to create meaningful relationships with their children can offer a positive lifelong influence and mitigate the impact of adverse childhood experiences (McPherson, Gatwiri, Tucci, Mitchell, & Macnamara, 2018). Given the number of children in foster care, the development of evidence-based parenting programs that support foster parents and empirical evaluations of such programs are of paramount importance (Dozier, Albus, Fisher, & Sepulveda, 2002). ...
Family Minds is a brief group psychoeducational parenting intervention designed to increase the reflective functioning (RF) and mentalization skills of foster parents. RF is important for foster parents who have to build relationships with children whose adverse experiences increase their risk for psychosocial challenges. A randomized controlled trial (RCT) for Family Minds was conducted in Texas with 89 foster parents. The main aims of this study were to examine whether the intervention could significantly increase the RF/mentalization skills of the foster parents and decrease their parenting stress. After 6 weeks, compared with the control group, intervention foster parents improved their RF via a lowering of pre-mentalizing and also significantly decreased parenting stress related to parent–child dysfunctional interactions. Other measures of RF and parenting stress showed no significant differences between groups. Foster child behavior was not significantly different between groups, although data at 6 months showed a possible lowering of internalizing symptoms for children of intervention parents. This RCT provides some encouraging evidence that Family Minds may increase RF in foster parents, improve parental sensitivity and their ability to emotionally regulate, decrease parenting stress related to challenging interactions with their foster children, and possibly decrease children's internalizing behavior.
... Supportive foster parents can help children cope with the effects of their adverse experiences by building a positive relationship with their foster child (Smyke & Breidenstine, 2019). Foster parents' efforts to create meaningful relationships with their children can offer a positive lifelong influence and mitigate the impact of adverse childhood experiences (McPherson, Gatwiri, Tucci, Mitchell, & Macnamara, 2018). Given the number of children in foster care, the development of evidence-based parenting programs that support foster parents and empirical evaluations of such programs are of paramount importance (Dozier, Albus, Fisher, & Sepulveda, 2002). ...
Family Minds is a group psychoeducational parenting intervention designed to increase reflective functioning (RF). RF involves parents’ capacity to understand their child’s mind and behavior. RF is important for foster parents who have to build relationships with children whose adverse experiences increase risk for psychosocial challenges.
An RCT for Family Minds was conducted with 89 foster parents. It was hypothesized that compared to the control group: (1) intervention foster parents would show a greater increase in RF, (2) a greater decrease in parenting stress, and (3) intervention foster children would show a greater decrease in psychosocial difficulties.
Family Minds was administered in three, three-hour modules across 4-6 weeks.
When compared with the control group, after six weeks the intervention foster parents showed a significantly greater increase in RF and a greater decrease in parenting stress. Foster child behavior was not significantly different between intervention and control groups, however, exploratory analysis at six months showed possibly lower internalizing symptoms for children of intervention parents.
This RCT demonstrated the effectiveness of Family Minds to increase RF in foster parents, decrease parenting stress, and possibly decrease children’s internalizing behavior. In only three sessions, Family Minds is an effective way to support foster families.
... A key element of the TrACK program includes coordinated therapeutic intervention for carers to establish and maintain a therapeutic milieu within the carer's home. This central focus of the program involves meeting the carer's needs for training, mentoring and day-to-day coaching to enable them to establish and maintain a relationship that actively addresses the impact of the trauma experienced by the child in past relationships (McPherson et al. 2018). The specialised training for carers includes material on the neurobiology of trauma and brain development, and a suite of helpful responses to trauma-based behaviours. ...
This paper discusses two key strategies detailing how “relationship-focused” and “trauma-informed” intervention practices, which form the basis of an Australian therapeutic program called Treatment and Care for Kids (TrACK), made a difference in the lives of highly traumatised children. The TrACK program fosters highly traumatised children who, due to the complexity of their trauma needs, cannot be placed in traditional generalist foster care. Case files of 48 children were reviewed. Children were either current or former clients over a period of 18 years since the program was initiated. In analysing the data, we noticed that children who were once highly dysregulated in the domains of foster care placement, education, arousal regulation and peer relationships were now enjoying an enhanced level of stability in their lives.
Background
Establishing and maintaining relationships and ways of connecting and being with others is an important component of health and wellbeing. Harnessing the relational within caring, supportive, educational, or carceral settings as a systems response has been referred to as relational practice. Practitioners, people with lived experience, academics and policy makers, do not yet share a well-defined common understanding of relational practice. Consequently, there is potential for interdisciplinary and interagency miscommunication, as well as the risk of policy and practice being increasingly disconnected. Comprehensive reviews are needed to support the development of a coherent shared understanding of relational practice.
Method
This study uses a scoping review design providing a scope and synthesis of extant literature relating to relational practice focussing on organisational and systemic practice. The review aimed to map how relational practice is used, defined and understood across health, criminal justice, education and social work, noting any impacts and benefits reported. Searches were conducted on 8 bibliographic databases on 27 October 2021. English language articles were included that involve/discuss practice and/or intervention/s that prioritise interpersonal relationships in service provision, in both external (organisational contexts) and internal (how this is received by workers and service users) aspects.
Results
A total of 8010 relevant articles were identified, of which 158 met the eligibility criteria and were included in the synthesis. Most were opinion-based or theoretical argument papers ( n = 61, 38.60%), with 6 (3.80%) critical or narrative reviews. A further 27 (17.09%) were categorised as case studies, focussing on explaining relational practice being used in an organisation or a specific intervention and its components, rather than conducting an evaluation or examination of the effectiveness of the service, with only 11 including any empirical data. Of the included empirical studies, 45 were qualitative, 6 were quantitative, and 9 mixed methods studies. There were differences in the use of terminology and definitions of relational practice within and across sectors.
Conclusion
Although there may be implicit knowledge of what relational practice is the research field lacks coherent and comprehensive models. Despite definitional ambiguities, a number of benefits are attributed to relational practices.
Systematic review registration
PROSPERO CRD42021295958
Health outcomes for young people living in residential out-of-home care are poor. There has been increased emphasis on the need to prioritize preventative support and upskill residential care workers to better meet young people's health needs. The aim of this study was to examine the food quality and physical activity environment in residential care houses in Victoria, Australia prior to staff undertaking Healthy Eating, Active Living Matters (HEAL) training; 102 residential care houses participated. House representatives completed an online survey exploring: (1) physical activity equipment and engagement and (2) weekly food budget and expenditure.
Findings
The average weekly food expenditure per household was $318.98 (SD = $106.51), with variation between different sized households. The majority (61%) of houses’ weekly food expenditure was spent on ultra-processed food products that are ready to eat with no/little preparation, in comparison to 36% spent on unprocessed foods (fresh fruit and vegetables). The majority of houses reported having two types of equipment. Young people were not often engaged in physical and/or recreational activities in their community.
Application
Residential care houses in Victoria require additional supports to ensure that young people are supported to eat well and be active at home and in the community. HEALing Matters aims to provide this, by offering professional development for residential carers to better facilitate engagement in physical activity and healthy eating among the young people in their care. If successful, HEALing Matters may provide an effective pathway to improved health and wellbeing outcomes for young people in residential care.
Exposure to intimate partner violence (IPV) between parents or caregivers can result in lifelong mental, physical, and relational challenges for children. Although the impacts of IPV on children are well documented, the aim of this systematic review was to be the first to synthesize the literature on children’s perspectives of fathers who have perpetrated IPV. Five electronic databases were searched using a string of search terms relating to the variables of interest. In total, 11,40 records were obtained from the database search. Screening based on a strict inclusion and exclusion criteria yielded 24 qualitative articles addressing the perceptions of children concerning fathers who perpetrate IPV. Research capturing the views of children regarding fathers who perpetrate IPV is scant. The current review highlights that children experience a range of feelings about their perpetrating fathers, including fear, anger, hatred, as well as ambivalence and love toward their father and children often have difficulty integrating contradictory experiences of their fathers’ behaviors. Father–child relationships are severely affected by IPV, including their fathers’ use of coercive control, even after the parents have separated. Finally, children’s experiences of their fathers’ attempts at behavior change varied. More research is needed to understand the views of children in this area, with consideration given to children’s developmental stage and the type of IPV experienced. Recommendations for research and interventions for children and families are emphasized further within this review.
This paper presents a case study that discusses the lived experiences of two LGBTIQA+ young people who have been in out-of-home care in Australia, focusing particularly on the influence of relationships on their developing sexual identity. Utilising a secure base theoretical perspective, we argue that how young people experience support, care and safety may depend on the relational context in which it is received, and that warm, loving relationships may be just as significant for the development of positive gender and sexual identities as explicit support for identity formation. The findings from the two narratives provide an argument in favour of the secure base model to support young LGBTIQA+ people in out-of-home care.
It is critical that those working with Aboriginal and Torres Strait Islander communities acknowledge and understand the impacts of trauma in order to engage in culturally safe practice. Recognising the role that historical and other traumas play in Indigenous people's communities and lives is a prerequisite for respectful and safe practice. Culturally safe, trauma-informed practice training makes cultural safety more achievable. Organisations that are serious about working and partnering with Aboriginal and Torres Strait Islander peoples are becoming 'trauma informed'. Aboriginal and Torres Strait Islander peoples are drawing immense strength and hope from understanding trauma and its impact on their lives. Sharing this knowledge with Aboriginal and Torres Strait Islander populations also has the potential to create safe healing spaces and interrupt trauma being passed on through generations. Trauma-informed cultural safety can allow profound change for individuals and the systems within which they practice.
More than three decades ago, the United Nations Convention on the Rights of the Child signalled to an international audience that all children under the age of 18 years are to be regarded as having certain rights. These rights include the right to be actively involved in decisions that affect their lives. In spite of this international obligation, which has been translated globally into policy and legislation across the world, little is known about the extent to which it is enacted in practice for young people living in residential care. This article reports on a systematic scoping review which investigated research publications on participation in making life-impacting decisions by young people. A critical theoretical lens was applied to the collation and analysis of publications, enabling a multidimensional presentation of five emerging themes. The implications for practice and policy include the need for organisations to challenge professional attitudes and disrupt practices which exclude young people from participating in decisions that impact on their lives, and for residential care staff and social workers to provide information and safe and inclusive spaces to support young people to form and express their views. Having heard their views, responsible adults must then demonstrate that they have been taken seriously.
It has long been recognized that youth entering out-of-home care have traumatic experiences and their associated effects on emotional and behavioral wellbeing may be unrecognized, overlooked, or untreated. An assessment to identify youth needs is vital as an initial step to youth in out-of-home care receiving needed treatment. Standardized assessments in particular can serve as an effective starting point in addressing the needs of these youth. This study explored if domains of the Child and Adolescent Needs and Strengths assessment were associated with a prescribed trauma-focused treatment. Bivariate and multivariate analyses were conducted utilizing a cross-section of child welfare involved youth who were part of the out-of-home care system and received a CANS assessment. Results from this study suggest the most predictive CANS domains were ‘emotional behavioral needs’ followed by ‘caregiver/ needs and strengths’. There was a sizeable portion of youth in the study with identified trauma-related symptoms who were not prescribed a trauma-focused treatment; which is consistent with prior research and suggests traumatized youth in out-of-home care are undertreated. More investigation of youth who have been assessed to have trauma-related needs, but who have not been assigned a trauma-focused treatment is needed. Findings have training and supervision implications for child welfare and behavioral health providers, and can aid in understanding the characteristics and needs of the youth served. Using similar language from standardized assessments allow child welfare and behavioral health workers to better communicate and collaborate to serve youth. Findings from this study promote evidence-informed practice in child welfare and behavioral health in order to better serve children and families.
In Latin America, little research has been conducted regarding exposure to adverse childhood experiences (ACEs), mental health, and health-related quality of life (HRQoL) among foster children. This study examined the association between ACEs and mental health, posttraumatic stress disorder (PTSD), and HRQoL in Chilean foster girls relative to age-matched Chilean family girls. Data were obtained from 27 Chilean foster girls and 27 Chilean girls ages 6 to 17 years living in family homes. Standardized self- and proxy-report measures were used. Foster girls reported more ACEs than controls in terms of familial and nonfamilial sexual abuse and both emotional and physical neglect. Girls living in foster care had a significantly higher rate of PTSD, displayed greater behavioral and emotional problems, and reported a lower HRQoL. Analysis confirmed the well-known cumulative risk hypothesis by demonstrating a significant positive association between the number of ACEs and PTSD symptom severity and a significant negative association with HRQoL. Chilean foster girls endured more ACEs that impair mental health and HRQoL than age-matched peers living with their families. These findings have implications for out-of-home care services in Latin America, highlighting the need to implement not only appropriate trauma-focused treatments but also appropriate prevention strategies. (PsycINFO Database Record
(c) 2015 APA, all rights reserved).
This paper describes the Multidimensional Treatment Foster Care program (MTFC), an evidence based approach for providing psychotherapeutic treatment for very troubled children and adolescents that is an alternative to residential care. Versions of the MTFC program have been developed and validated for young children with a history of maltreatment as well as for older children and adolescents who are involved with the youth justice system. In the paper we describe the development of the MTFC program and its foundations in the social learning model that originated at the Oregon Social Learning Center in the 1960's and 70's. We present information about program elements. We then review the research that has been conducted on MTFC.
There is controversy over whether childhood trauma (CT) is a causal risk factor for psychosis. The aim of this study was to provide psychologists with a brief overview of the research into relationship between childhood trauma and psychosis and directions for psychological interventions. It details six of the highest quality studies in the area and tentatively concludes from these that there is evidence for a relationship between CT and psychosis. Hallucinations and delusions have been implicated as important factors in the relationship between CT and psychotic disorder and these are discussed, along with post-traumatic intrusions and schemas, which have been conceptualised as part of the psychological mechanisms whereby CT confers a risk for psychosis. The development of psychological interventions for people with psychosis who have experienced CT is in its infancy but has been based on evidence-based cognitive behavioural interventions in psychosis and post-traumatic stress disorder. A formulation-based approach is described in this paper, along with a case study.
Children in care often have poor outcomes. There is a lack of evaluative research into intervention options.
To examine the efficacy of Multidimensional Treatment Foster Care for Adolescents (MTFC-A) compared with usual care for young people at risk in foster care in England.
A two-arm single (assessor) blinded randomised controlled trial (RCT) embedded within an observational quasi-experimental case-control study involving 219 young people aged 11-16 years (trial registration: ISRCTN 68038570). The primary outcome was the Child Global Assessment Scale (CGAS). Secondary outcomes were ratings of educational attendance, achievement and rate of offending.
The MTFC-A group showed a non-significant improvement in CGAS outcome in both the randomised cohort (n = 34, adjusted mean difference 1.3, 95% CI -7.1 to 9.7, P = 0.75) and in the trimmed observational cohort (n = 185, adjusted mean difference 0.95, 95% CI -2.38 to 4.29, P = 0.57). No significant effects were seen in secondary outcomes. There was a possible differential effect of the intervention according to antisocial behaviour.
There was no evidence that the use of MTFC-A resulted in better outcomes than usual care. The intervention may be more beneficial for young people with antisocial behaviour but less beneficial than usual treatment for those without.
Thematic analysis is a poorly demarcated, rarely acknowledged, yet widely used qualitative analytic method within psychology. In this paper, we argue that it offers an accessible and theoretically flexible approach to analysing qualitative data. We outline what thematic analysis is, locating it in relation to other qualitative analytic methods that search for themes or patterns, and in relation to different epistemological and ontological positions. We then provide clear guidelines to those wanting to start thematic analysis, or conduct it in a more deliberate and rigorous way, and consider potential pitfalls in conducting thematic analysis. Finally, we outline the disadvantages and advantages of thematic analysis. We conclude by advocating thematic analysis as a useful and flexible method for qualitative research in and beyond psychology.
Childhood maltreatment is a stressor that can lead to the development of behavior problems and affect brain structure and function. This review summarizes the current evidence for the effects of childhood maltreatment on behavior, cognition and the brain in adults and children. Neuropsychological studies suggest an association between child abuse and deficits in IQ, memory, working memory, attention, response inhibition and emotion discrimination. Structural neuroimaging studies provide evidence for deficits in brain volume, gray and white matter of several regions, most prominently the dorsolateral and ventromedial prefrontal cortex but also hippocampus, amygdala, and corpus callosum (CC). Diffusion tensor imaging (DTI) studies show evidence for deficits in structural interregional connectivity between these areas, suggesting neural network abnormalities. Functional imaging studies support this evidence by reporting atypical activation in the same brain regions during response inhibition, working memory, and emotion processing. There are, however, several limitations of the abuse research literature which are discussed, most prominently the lack of control for co-morbid psychiatric disorders, which make it difficult to disentangle which of the above effects are due to maltreatment, the associated psychiatric conditions or a combination or interaction between both. Overall, the better controlled studies that show a direct correlation between childhood abuse and brain measures suggest that the most prominent deficits associated with early childhood abuse are in the function and structure of lateral and ventromedial fronto-limbic brain areas and networks that mediate behavioral and affect control. Future, large scale multimodal neuroimaging studies in medication-naïve subjects, however, are needed that control for psychiatric co-morbidities in order to elucidate the structural and functional brain sequelae that are associated with early environmental adversity, independently of secondary co-morbid conditions.
This study was conducted in order to evaluate the effects of mental health and quality of life (QOL) in children and adolescents living in residential and foster care.
Two hundred and sixteen children and adolescents, aged 8-18 years, from residential and foster care participated. QOL was assessed using the Pediatric Quality-of-Life Inventory (PedsQL), levels of anxiety and depressive symptoms using the screen for child anxiety-related emotional disorders (SCARED) questionnaire and the short mood and feeling questionnaire (SMFQ), and general mental health through use of the strengths and difficulties questionnaire (SDQ).
The children and adolescents from residential care had significantly low QOL and more frequently had mental health problems. A stepwise linear regression was performed to test the associations between the SCARED, SMFQ and SDQ scores, and PedsQL (QOL). Anxiety, depressive symptoms and general mental difficulties account for significant variations in QOL (p < 0.001).
Mental health problems have significant negative effects on the QOL of children and adolescents living in residential and foster care.
Strong, graded relationships between exposure to childhood traumatic stressors and numerous negative health behaviors and outcomes, healthcare utilization, and overall health status inspired the question of whether these adverse childhood experiences (ACEs) are associated with premature death during adulthood.
This study aims to determine whether ACEs are associated with an increased risk of premature death during adulthood.
Baseline survey data on health behaviors, health status, and exposure to ACEs were collected from 17,337 adults aged >18 years during 1995-1997. The ACEs included abuse (emotional, physical, sexual); witnessing domestic violence; parental separation or divorce; and growing up in a household where members were mentally ill, substance abusers, or sent to prison. The ACE score (an integer count of the eight categories of ACEs) was used as a measure of cumulative exposure to traumatic stress during childhood. Deaths were identified during follow-up assessments (between baseline appointment date and December 31, 2006) using mortality records obtained from a search of the National Death Index. Expected years of life lost (YLL) and years of potential life lost (YPLL) were computed using standard methods. The relative risk of death from all causes at age < or =65 years and at age < or =75 years was estimated across the number of categories of ACEs using multivariable-adjusted Cox proportional hazards regression. Analysis was conducted during January-February 2009.
Overall, 1539 people died during follow-up; the crude death rate was 91.0 per 1000; the age-adjusted rate was 54.7 per 1000. People with six or more ACEs died nearly 20 years earlier on average than those without ACEs (60.6 years, 95% CI=56.2, 65.1, vs 79.1 years, 95% CI=78.4, 79.9). Average YLL per death was nearly three times greater among people with six or more ACEs (25.2 years) than those without ACEs (9.2 years). Roughly one third (n=526) of those who died during follow-up were aged < or =75 years at the time of death, accounting for 4792 YPLL. After multivariable adjustment, adults with six or more ACEs were 1.7 (95% CI=1.06, 2.83) times more likely to die when aged < or =75 years and 2.4 (95% CI=1.30, 4.39) times more likely to die when aged < or =65 years.
ACEs are associated with an increased risk of premature death, although a graded increase in the risk of premature death was not observed across the number of categories of ACEs. The increase in risk was only partly explained by documented ACE-related health and social problems, suggesting other possible mechanisms by which ACEs may contribute to premature death.
Policy makers have widely endorsed the idea that educational and economic achievement are a function of early childhood experience and development and can be improved through interventions such as preschool.¹,2 However, they have yet to fully embrace that adolescent and adult health is also profoundly affected by early childhood experiences and can similarly be improved through wise public investments. Neurobiological, behavioral, and social science research conclusively shows that early adverse experiences can affect brain development and increase vulnerability to a broad range of mental and physical health problems.³- 5 In addition, health depends on developing psychological, behavioral, and social competencies built on a foundation of safety, stability, and nurturance that is laid down early in life and that buffers against early adversity.³,5
Ever since people's responses to overwhelming experiences have been systematically explored, researchers have noted that a trauma is stored in somatic memory and expressed as changes in the biological stress response. Intense emotions at the time of the trauma initiate the long-term conditional responses to reminders of the event, which are associated both with chronic alterations in the physiological stress response and with the amnesias and hypermnesias characteristic of posttraumatic stress disorder (PTSD). Continued physiological hyperarousal and altered stress hormone secretion affect the ongoing evaluation of sensory stimuli as well. Although memory is ordinarily an active and constructive process, in PTSD failure of declarative memory may lead to organization of the trauma on a somatosensory level (as visual images or physical sensations) that is relatively impervious to change. The inability of people with PTSD to integrate traumatic experiences and their tendency, instead, to continuously relieve the past are mirrored physiologically and hormonally in the misinterpretation of innocuous stimuli as potential threats. Animal research suggests that intense emotional memories are processed outside of the hippocampally mediated memory system and are difficult to extinguish. Cortical activity can inhibit the expression of these subcortically based emotional memories. The effectiveness of this inhibition depends, in part, on physiological arousal and neurohormonal activity. These formulations have implications for both the psychotherapy and the pharmacotherapy of PTSD.
This study examined change in attachment-related behaviors among foster preschoolers participating in a randomized trial of the Multidimensional Treatment Foster Care Program for Preschoolers (MTFC-P). Measures of secure, resistant, and avoidant behaviors were collected using a caregiver-report diary at 3-month intervals during the 12 months following a new foster placement. Children randomly assigned to the MTFC-P intervention condition (n = 57) showed significant increases in secure behavior and significant decreases in avoidant behavior relative to children assigned to a regular foster care condition (n = 60). Both groups showed significant decreases in resistant behavior over time. Analyses also revealed a significant interaction between treatment condition and age at first foster placement on change in secure behavior. Results are discussed in terms of the importance of early intervention and prevention services for foster preschoolers.
Adverse childhood experiences (ACEs) have been consistently linked to psychiatric difficulties in children and adults. However, the long-term effects of ACEs on mental health during the early adult years have been understudied. In addition, many studies are methodologically limited by use of non-representative samples, and few studies have investigated gender and racial differences. The current study relates self-reported lifetime exposure to a range of ACEs in a community sample of high school seniors to three mental health outcomes-depressive symptoms, drug abuse, and antisocial behavior-two years later during the transition to adulthood.
The study has a two-wave, prospective design. A systematic probability sample of high school seniors (N = 1093) was taken from communities of diverse socioeconomic status. They were interviewed in person in 1998 and over the telephone two years later. Gender and racial differences in ACE prevalence were tested with chi-square tests. Each mental health outcome was regressed on one ACE, controlling for gender, race/ethnicity, and SES to obtain partially standardized regression coefficients.
Most ACEs were strongly associated with all three outcomes. The cumulative effect of ACEs was significant and of similar magnitude for all three outcomes. Except for sex abuse/assault, significant gender differences in the effects of single ACEs on depression and drug use were not observed. However, boys who experienced ACEs were more likely to engage in antisocial behavior early in young adulthood than girls who experienced similar ACEs. Where racial/ethnic differences existed, the adverse mental health impact of ACEs on Whites was consistently greater than on Blacks and Hispanics.
Our sample of young adults from urban, socio-economically disadvantaged communities reported high rates of adverse childhood experiences. The public health impact of childhood adversity is evident in the very strong association between childhood adversity and depressive symptoms, antisocial behavior, and drug use during the early transition to adulthood. These findings, coupled with evidence that the impact of major childhood adversities persists well into adulthood, indicate the critical need for prevention and intervention strategies targeting early adverse experiences and their mental health consequences.
Parent training for foster parents is mandated by federal law and supported by state statues in nearly all states; however, little is known about the efficacy of that training, and recent reviews underscore that the most widely used curricula in the child welfare system (CWS) have virtually no empirical support (Grimm, Youth Law News, April-June:3-29, 2003). On the other hand, numerous theoretically based, developmentally sensitive parent training interventions have been found to be effective in experimental clinical and prevention intervention trials (e.g., Kazdin and Wassell, Journal of the American Academy of Child and Adolescent Psychiatry, 39:414-420, 2000; McMahon and Forehand, Helping the noncompliant child, Guilford Press, New York, USA, 2003; Patterson and Forgatch, Parents and adolescents: I. Living together, Castalia Publishing, Eugene, OR, USA, 1987; Webster-Stratton et al., Journal of Clinical Child Pyschology Psychiatry, 42:943-952, 2001). One of these, Multidimensional Treatment Foster Care (MTFC; Chamberlain, Treating chronic juvenile offenders: Advances made through the Oregon Multidimensional Treatment Foster Care model, American Psychological Association, Washington, DC, USA, 2003), has been used with foster parents of youth referred from juvenile justice. The effectiveness of a universal intervention, KEEP (Keeping Foster Parents Trained and Supported) based on MTFC (but less intensive) was tested in a universal randomized trial with 700 foster and kinship parents in the San Diego County CWS. The goal of the intervention was to reduce child problem behaviors through strengthening foster parents' skills. The trial was designed to examine effects on both child behavior and parenting practices, allowing for specific assessment of the extent to which improvements in child behavior were mediated by the parenting practices targeted in the intervention. Child behavior problems were reduced significantly more in the intervention condition than in the control condition, and specific parenting practices were found to mediate these reductions, especially for high-risk children in foster families reporting more than six behavior problems per day at baseline.
This paper reviews the findings of the South Australian longitudinal study and the extent to which findings are borne out in subsequent national and international research. Included in this paper is an analysis of several issues in out-of-home care, including the disparity between child and carer numbers, the nature and effects of placement instability, the complexity of child behaviour and family contact. Using some recent findings of the ongoing National Survey of Child and Adolescent Well-being (NSCAW) study in the United States, the paper shows how many of the South Australian findings have been also borne out in other studies with larger sample sizes and more sophisticated measures. These comparisons suggest that the out-of-home care experiences of children living in both countries may share many similarities. Findings obtained in either country may be more easily translated to inform policy and practice internationally than has been previously thought.
Nina Biehal, Sarah Ellison and Ian Sinclair present the results of an independent evaluation of the Multidimensional Treatment Foster Care (MTFC) programme for young offenders in England, where it is known as Intensive Fostering (IF). A quasi-experimental, mixed-methods study was carried out at the three pilot sites, with a total sample of 47 at follow-up. Young people sentenced to IF were compared to a similar group, matched on the eligibility criteria for IF, the majority of whom were sentenced to custody. The groups were well matched in terms of their characteristics and criminal histories. Official data on reconviction were collected at baseline and one year after entry to the IF placement or release from custody (Stage 1), and further data on programme completion and secondary outcomes were collected via interviews with young people and parents, and questionnaires to professionals at baseline and follow-up. Official data on reconviction were also collected one year after exit from the IF placements (Stage 2). At Stage 1 the IF group were less likely to be reconvicted, had committed fewer and less-serious recorded offences, on average, and took longer to commit their first recorded offence. At this point the IF group were more likely to be living with their families and less likely to be in custody than the comparison group. However, by Stage 2 no significant differences in patterns of reconviction remained. IF successfully contained a high-risk group in the community, but the effects of the intervention diminished once they left their foster placements. Environmental effects on entry to and exit from the IF placements may help to explain the results at both stages.
Despite good reason to believe that children in foster care are disproportionately exposed to adverse childhood experiences (ACEs), relatively little research considers exposure to ACEs among this group of vulnerable children. In this article, we use data from the 2011–2012 National Survey of Children’s Health (NSCH), a nationally representative sample of non-institutionalized children ages 0–17 in the United States, to estimate the association between foster care placement and exposure to an array of ACEs. In adjusted logistic regression models, we find that children placed in foster care or adopted from foster care, compared to their counterparts, were more likely to experience parental divorce or separation, parental death, parental incarceration, parental abuse, violence exposure, household member mental illness, and household member substance abuse. These children were also more likely to experience ACEs than children across different thresholds of socioeconomic disadvantage (e.g., children in households with incomes below the poverty line) and across different family structures (e.g., children in single-mother families). These results advance our understanding of how children in foster care, an already vulnerable population, are disproportionately exposed to ACEs. This exposure, given the link between ACEs and health, may have implications for children’s health and wellbeing throughout the life course.
How best to support children and young people in foster care remains a challenge for child welfare. There has been little Australian research on the outcomes for children and young people placed in therapeutic foster care (TFC). This article aims to address this knowledge gap, presenting the evaluation of a state-wide model of TFC known as the Circle Program operating in Victoria, Australia. Data sources for the study were case assessment analysis; surveys of foster carers, program workers and other stakeholders in the sector; and both focus groups and individual interviews with foster care workers. The evaluation found that the Circle Program lessened the number of unplanned exits of children from foster placements compared with generalist foster care. Another important finding was that the Circle Program positively influenced foster carers' decisions to stay in the carer role. Key components perceived as contributing to outcomes of the Circle Program included enhanced training of foster carers, intensive carer support, specialist therapeutic support to the child and carer, therapeutic service to family members and a network of services to provide support to the child.
Background:
Childhood maltreatment is the most important preventable cause of psychopathology accounting for about 45% of the population attributable risk for childhood onset psychiatric disorders. A key breakthrough has been the discovery that maltreatment alters trajectories of brain development.
Methods:
This review aims to synthesize neuroimaging findings in children who experienced caregiver neglect as well as from studies in children, adolescents and adults who experienced physical, sexual and emotional abuse. In doing so, we provide preliminary answers to questions regarding the importance of type and timing of exposure, gender differences, reversibility and the relationship between brain changes and psychopathology. We also discuss whether these changes represent adaptive modifications or stress-induced damage.
Results:
Parental verbal abuse, witnessing domestic violence and sexual abuse appear to specifically target brain regions (auditory, visual and somatosensory cortex) and pathways that process and convey the aversive experience. Maltreatment is associated with reliable morphological alterations in anterior cingulate, dorsal lateral prefrontal and orbitofrontal cortex, corpus callosum and adult hippocampus, and with enhanced amygdala response to emotional faces and diminished striatal response to anticipated rewards. Evidence is emerging that these regions and interconnecting pathways have sensitive exposure periods when they are most vulnerable.
Conclusions:
Early deprivation and later abuse may have opposite effects on amygdala volume. Structural and functional abnormalities initially attributed to psychiatric illness may be a more direct consequence of abuse. Childhood maltreatment exerts a prepotent influence on brain development and has been an unrecognized confound in almost all psychiatric neuroimaging studies. These brain changes may be best understood as adaptive responses to facilitate survival and reproduction in the face of adversity. Their relationship to psychopathology is complex as they are discernible in both susceptible and resilient individuals with maltreatment histories. Mechanisms fostering resilience will need to be a primary focus of future studies.
Inconsistencies exist in the current literature regarding hypothalamic-pituitary-adrenal (HPA) regulation following exposure to repeated stressful events. These inconsistencies stem, in part, from the limitations imposed by measuring cortisol in saliva or plasma (i.e. "point measures" of HPA activity). The present study used a cross-sectional, correlational design to examine the relationship between childhood stress (assessed using the adverse childhood experiences [ACEs] questionnaire) and hair cortisol (a biomarker of chronic HPA activity) in 55 healthy 18-24-year-old college students. Dichotomous ACE score for two models using different cut-points was significantly, inversely related to hair cortisol level (B = 1.03, p = 0.046 and B = 1.09, p = 0.031). These results are consistent with theoretical models where exposure to repeated stressful events results in chronic HPA dysregulation, which may include down-regulation under certain conditions.
Children enter foster care with many forms of adversity and trauma beyond maltreatment that impact their short- and long-term physical, mental, and developmental health and their adaptation to their new care environment. Applying an understanding of the impact of toxic stress on the developing brain and body allows the health care provider to understand findings in this vulnerable population. Complex trauma alters immune response, neurodevelopment, and the genome, resulting in predictable and significant cognitive, behavioral, and physical consequences. Pediatric care of children in foster care must be trauma informed to meet their medical, mental health, and developmental needs.
This paper focuses on scoping studies, an approach to reviewing the literature which to date has received little attention in the research methods literature. We distinguish between different types of scoping studies and indicate where these stand in relation to full systematic reviews. We outline a framework for conducting a scoping study based on our recent experiences of reviewing the literature on services for carers for people with mental health problems. Where appropriate, our approach to scoping the field is contrasted with the procedures followed in systematic reviews. We emphasize how including a consultation exercise in this sort of study may enhance the results, making them more useful to policy makers, practitioners and service users. Finally, we consider the advantages and limitations of the approach and suggest that a wider debate is called for about the role of the scoping study in relation to other types of literature reviews.
This study examined psychiatric diagnoses and adverse childhood experiences in a matched sample (n = 144) of children enrolled in standard or treatment foster care programs and their associations with discharge placement restrictiveness for children (n = 90) in treatment foster care. Medical record data were extracted on psychiatric diagnoses, adverse childhood experiences, and discharge placement restrictiveness. Children in treatment versus standard foster care had significantly more psychiatric diagnoses and adverse childhood experiences. The presence of bipolar and oppositional defiant disorder was associated with a more restrictive discharge placement. Even without standardized screening, children with more severe presentations are found in treatment versus standard foster care. These findings support the need for coordinated mental health services in treatment foster care.
This study focused on attachment of foster children by examining factors associated with attachment relationships of children raised from birth by the same parents. The sample included 61 children between 26 to 88 months of age and their foster caregivers. Attachment security and caregiver sensitivity were coded on the basis of, respectively, a home-observation (Attachment Q-Set) and a laboratory procedure (Three boxes). Other measures included caregiver reports of child externalizing and internalizing behavior problems and symptoms of attachment disorder, including inhibited and disinhibited attachment as well as secure base distortions. For a subsample of children, teacher ratings of behavior problems also were available. Foster parent sensitivity was positively associated with attachment security, but only if symptoms of disordered attachment were partialled out. Symptoms of inhibited and disinhibited attachment as well as secure base distortions were positively related to parent reports of externalizing and internalizing behavior problems whereas attachment security was negatively related to teacher reports of externalizing behavior problems. Attachment theoretical tenets appeared valid with foster parent–child relationships, except for children with symptoms of attachment disorder.
Qualitative research provides a valuable source of evidence to enhance occupational therapy practice. Occupational therapists need to consider the issue of trustworthiness prior to deciding whether the findings of qualitative research have relevance to their day-to-day work. By trustworthiness we mean the extent to which the findings are an authentic reflection of the personal or lived experiences of the phenomenon under investigation. In this article we provide guidance to enable occupational therapists to competently determine the trustworthiness of a qualitative research project. We do this by explaining, and illustrating with examples, six considerations that should be taken into account when determining whether the method, findings and interpretation of a qualitative research have been conducted in a trustworthy manner. These considerations are evidence of thick description, triangulation strategies, member-checking, collaboration between the researcher and the researched, transferability and reflexivity. Once the trustworthiness of a qualitative research has been determined, occupational therapists are in a better position to consider how the research findings may impact on their practice.
This review examined risk and protective factors associated with placement breakdown across k = 26 studies of 20,650 children in foster families. A series of meta-analyses were performed to assess the average effect sizes across multiple studies on the same factors. Older age at placement (k = 15), behavior problems (k = 13), a history of residential care (k = 7) and previous placements (k = 6) showed significant small to moderate associations with placement breakdown. A large combined effect size was found for behavior problems when analyzed in multivariate models. Unexpectedly, kinship care (k = 6) did not show a significant association with placement breakdown. Other potential protective factors of placement breakdown referred to the quality of foster caregiving and other foster care related aspects, which showed small to large effect sizes. However, findings were contradictory when univariate and multivariate results were compared. Results of multivariate studies suggested mediating and moderating effects of variables related to the children's background. This might suggest that more insight in the processes leading up to placement breakdown may be derived from causal models.
Children in substitute care have a much increased rate of psychosocial problems but also they come from high risk backgrounds. Risk and protective influences include: genetic factors; physical traumata; preadmission psychosocial experiences; experiences ‘in care’, and experiences after leaving care. Interplay among these is usual. Follow-up studies show the reality of resilience in the face of adversity but also they indicate persistent sequelae in some cases in spite of major environmental improvements. Key challenges for the present and future are considered with respect to: societal responses to parenting failure; adoption; family foster care; kinship foster care; and residential group care. Mainstream research needs to pay greater attention to policy and practice questions and action research needs to take better advantage of improvements in research methodology.
This Technical Report was retired November 2021
Advances in fields of inquiry as diverse as neuroscience, molecular biology, genomics, developmental psychology, epidemiology, sociology, and economics are catalyzing an important paradigm shift in our understanding of health and disease across the lifespan. This converging, multidisciplinary science of human development has profound implications for our ability to enhance the life prospects of children and to strengthen the social and economic fabric of society. Drawing on these multiple streams of investigation, this report presents an ecobiodevelopmental framework that illustrates how early experiences and environmental influences can leave a lasting signature on the genetic predispositions that affect emerging brain architecture and long-term health. The report also examines extensive evidence of the disruptive impacts of toxic stress, offering intriguing insights into causal mechanisms that link early adversity to later impairments in learning, behavior, and both physical and mental well-being. The implications of this framework for the practice of medicine, in general, and pediatrics, specifically, are potentially transformational. They suggest that many adult diseases should be viewed as developmental disorders that begin early in life and that persistent health disparities associated with poverty, discrimination, or maltreatment could be reduced by the alleviation of toxic stress in childhood. An ecobiodevelopmental framework also underscores the need for new thinking about the focus and boundaries of pediatric practice. It calls for pediatricians to serve as both front-line guardians of healthy child development and strategically positioned, community leaders to inform new science-based strategies that build strong foundations for educational achievement, economic productivity, responsible citizenship, and lifelong health.
Four decades of early childhood policy and program development indicate that evidence-based interventions can improve life outcomes, and dramatic advances in the biological and behavioral sciences now provide an opportunity to augment those impacts. The challenge of reducing the gap between what we know and what we do to promote the healthy development of young children is to view current best practices as a starting point and to leverage scientific concepts to inspire fresh thinking. This article offers an integrated, biodevelopmental framework to promote greater understanding of the antecedents and causal pathways that lead to disparities in health, learning, and behavior in order to inform the development of enhanced theories of change to drive innovation in policies and programs.
Foster children often experience compromising situations such as neglect, physical abuse, or sexual abuse before out-of-home placement. This article aims to give a literature review related to the development and mental health of foster children with special consideration of trauma history.
A computer-based literature search was conducted in the databases Medline, PsycINFO, PSYNDEXplus, and SCOPUS. We determined a time frame from 1998 to 2009.
The literature search resulted in 32 articles reporting empirical data about development and mental health in foster children. Very high rates of exposure to maltreatment, developmental delays and mental disorders were found. A broad spectrum of externalizing as well as internalizing symptoms and a high prevalence of comorbid mental disorders were found.
Foster children exhibit a broad pattern of developmental problems and psychopathology. The etiology of these disorders is discussed in the context of multiple risk factors, especially that of persistent maltreatment.
The authors investigated the relationship between childhood abuse and obesity in young adulthood (M age = 22) in a large, U.S. representative sample (N = 15,197). Controlling for demographics and depression, men with a history of childhood sexual abuse were at increased risk of overweight and obesity. No association between childhood abuse and obesity or overweight was observed for women in this sample. Higher percentages of skipping meals to lose weight and problematic eating were observed among women with a history of physical abuse. This is the first study to note an association between childhood abuse with obesity and problematic weight management behaviors in a sample of young adults.
To examine whether childhood traumatic stress increased the risk of developing autoimmune diseases as an adult.
Retrospective cohort study of 15,357 adult health maintenance organization members enrolled in the Adverse Childhood Experiences (ACEs) Study from 1995 to 1997 in San Diego, California, and eligible for follow-up through 2005. ACEs included childhood physical, emotional, or sexual abuse; witnessing domestic violence; growing up with household substance abuse, mental illness, parental divorce, and/or an incarcerated household member. The total number of ACEs (ACE Score range = 0-8) was used as a measure of cumulative childhood stress. The outcome was hospitalizations for any of 21 selected autoimmune diseases and 4 immunopathology groupings: T- helper 1 (Th1) (e.g., idiopathic myocarditis); T-helper 2 (Th2) (e.g., myasthenia gravis); Th2 rheumatic (e.g., rheumatoid arthritis); and mixed Th1/Th2 (e.g., autoimmune hemolytic anemia).
Sixty-four percent reported at least one ACE. The event rate (per 10,000 person-years) for a first hospitalization with any autoimmune disease was 31.4 in women and 34.4 in men. First hospitalizations for any autoimmune disease increased with increasing number of ACEs (p < .05). Compared with persons with no ACEs, persons with >or=2 ACEs were at a 70% increased risk for hospitalizations with Th1, 80% increased risk for Th2, and 100% increased risk for rheumatic diseases (p < .05).
Childhood traumatic stress increased the likelihood of hospitalization with a diagnosed autoimmune disease decades into adulthood. These findings are consistent with recent biological studies on the impact of early life stress on subsequent inflammatory responses.
While the phrase, "interminable foster care" is becoming a damning cliché in the dialogues of juvenile courts and child welfare organizations, many children are growing up in foster homes. Human love must move us to approve and enrich these foster families; childhood is too brief and important to be knowingly allowed disapproved or impoverished experience. This paper describes the foster situation: families, children, and the involved professionals. It then presents a teachable developmental theory weaved from threads of numerous known theories, and describes a process whereby "interminable" foster experience was used therapeutically for a group of handicapped homeless children.
There may be a number of specific foster care models that would facilitate infant development. The important point is that the emphasis should shift from foster care as maintenance to foster care as active intervention. Several other recent developments in public policy and public opinion suggest that the time is ripe for such a change; the federal government has mandated provision of early intervention services for young children at risk, and there is renewed interest in breaking the cycle of disadvantage. At this point, we must deal with the reality of the large number of infants and young children who enter the foster-care system and who stay for substantial periods of time. This situation represents an opportunity for professionals and foster parents alike to play a crucial role in changing the potentially adverse course of development for many children. It is an opportunity too important to be lost.
To report baseline mental health measures from the Children in Care study, a prospective epidemiological study of children in court-ordered foster and kinship care in New South Wales, Australia.
Mental health, socialization and self-esteem were assessed in 347 children in a statewide mail survey, using two carer-report checklists, the Child Behavior Checklist (CBCL) and the Assessment Checklist for Children (ACC).
Children in the study had exceptionally poor mental health and socialization, both in absolute terms, and relative to normative and in-care samples. Levels and rates of disturbance for children in foster care exceeded all prior estimates. Rates of disturbance for children in kinship care were high, but within the range of prior estimates. Boys presented with higher scope and severity of mental health problems than girls on the CBCL, while gender-specific patterns of disturbance were shown on the ACC. A moderate age effect was accounted for by children's age at entry into care.
Children in care are at high risk of mental health problems. Psychological support for the children and their carers is an essential secondary prevention strategy. Implications for service delivery are discussed.
Although foster care is generally seen as providing a positive experience for the children and young people for whom it caters, it is rarely conceived of as a place where the children are helped to address their emotional difficulties and modify their often difficult behaviour. Yet research evidence suggests that some foster carers are consistently less likely to have placements which break down, and that foster carers who show particular skills in parenting can make a difference to successful outcomes. The article draws on a large longitudinal study of foster care to argue that it is possible to learn from what these foster carers do in order to develop these skills in others. A model of successful foster care. developed from the main statistical part of the study is first described. Two cases from the qualitative, case-studies component of the research are then analysed to demonstrate a quality of responsive parenting. The model is further developed within the framework of the dynamic of attachment and interest sharing proposed by Heard and Lake (1997), to show how this can be used as a basis for future approaches to working with foster placements.
To compare the health-related quality of life (HRQL) of 326 children and adolescents aged 6-17 years living in home-based foster care in metropolitan Adelaide, South Australia with the HRQL of a random sample of 3,582 children aged 6-17 years living in the community in Australia.
In both groups, HRQL was assessed using the 50-item version of the Child Health Questionnaire (CHQ-PF50) completed by caregivers/parents, and the 87-item self-report version of the Child Health Questionnaire (CHQ-CF87) completed by 13-17 year olds.
Young people in home-based foster care had significantly poorer HRQL in a wide range of different domains than those in the general community. Furthermore, among children in home-based foster care, those with mental health problems had significantly poorer HRQL in many domains than those without mental health problems. Demographic and placement characteristics of the children in home-based foster care were not significantly associated with differences in HRQL.
The findings highlight the importance of providing services and resources to improve the quality of life of children living in home-based foster care.
The paper describes sibling-related investigations conducted within the first stage of a prospective study of the mental health of 347 children (aged 4–11) in foster and kinship care in New South Wales, Australia (the Children in Care Study). Mental health was measured with the Child Behavior Checklist and with a carer-report instrument designed to measure psychopathology specifically observed among children in care (the Assessment Checklist for Children). A large number of study factors were measured, including several confounders of sibling-related data. The analyses include: the distribution and stability of sibling placements; mental health and socialization estimates stratified by sibling placement status; and a within-pairs comparison of oldest-younger sibling dyads in shared placements. Girls separated from all of their siblings were reported to have significantly poorer mental health and socialization than girls residing with at least one sibling. Various hypotheses accounting for this gender-specific finding are proposed, with a view to being tested in the prospective stage of the study.
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A case study in attempted reform in out of home care: A preliminary examination of the introduction of the circle therapeutic foster care program in Victoria
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Outcomes for children in care
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The science of the art of psychotherapy
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Fostering now: Messages from research
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