Perceived social support: Measurement differences in youth residing in the community versus youth residing in foster care

BACKGROUND

Social support is commonly examined as a protective factor for children with a history of child maltreatment, and it has been measured by self-report via the Social Support Scale for Children (SSSC). Although the SSSC has established adequate reliability and validity in community and clinical samples, its psychometric properties have yet to be assessed in a sample of foster care youth.

OBJECTIVE

This study provided a psychometric comparison of the SSSC in youth residing in foster care with youth residing in the community.

PARTICIPANTS AND SETTING

Participants were two, comparable samples of 214 youth participants residing in foster care and 163 youth participants from the community between the ages of 8-12 years.

METHODS

Community participants were recruited from local middle schools, and an age-matched comparison sample from a larger study on youth in foster care was utilized for comparison. Youth self-reported across measures and provided demographic information. Confirmatory factor analysis was utilized to determine measurement model fit to the data, and invariance testing was conducted to compare measurement models across the samples.

RESULTS

Differences between samples in the factor structure and item distribution of the SSSC emerged. Specifically, the community sample provided adequate fit to the original four-factor model (friend, classmate, teacher, parent) of the SSSC, whereas the foster sample required a three-factor model (combined friend and classmate constructs). The newly defined three-factor model provided significant associations with youth behavioral and emotional outcomes.

CONCLUSIONS

Youth in foster care may perceive social support across sources differently from youth residing in the community.

Translating and Implementing Evidence-Based Mental Health Services in Child Welfare

Children in the child welfare system with mental health difficulties seldom receive evidence-based treatment (EBT) despite the abundance of validated interventions that exist. This manuscript describes two projects aimed at increasing access to EBTs. The first is a completed field trial of an adapted parent-child interaction therapy intervention with foster-parent child dyads. New findings are presented from variable- and person-centered analyses of impact on diverse symptom profiles. The second is an ongoing statewide initiative that is increasing access to multiple EBTs while navigating implementation barriers. Lessons learned for bridging gaps between children's mental health research, services, and policy are discussed.

Measuring self-reported polyvictimization in foster youth research: A systematic review

BACKGROUND

Youth who are or have been in foster care (foster youth) are at higher risk for adverse outcomes in early adulthood. As the importance and complexity of victimization experiences, including types, timing, and perpetrators, is better understood it is unclear whether or to what extent the research on foster youth assesses polyvictimization. Because many types of victimization, such as community violence, are under-reported or absent in the administrative data typically used for research with foster care populations, self-reports of victimization experiences are necessary to comprehensively assess polyvictimization. Polyvictimization places youth at increased risk for adverse outcomes, and yet is not widely measured in the foster youth population. This is likely in part due to the wide-use of administrative reports to assess maltreatment among research on foster youth which does not capture a full range of victimization experiences.

OBJECTIVE

The aim of the present study was to systematically review and evaluate the measurement of self-reported polyvictimization with foster youth samples.

METHODS

A search in Academic Search Premier, MEDLINE, PsycARTICLES, Psychology and Behavioral Sciences Collection, Social Work Abstracts, SociINDEX, and Scopus was conducted. Articles included peer-reviewed, quantitative research studies that measured self-reported victimization (including violence exposure and/or maltreatment) with foster youth samples between 1997-2017. In total, 1887 studies were identified and reviewed by two raters and of those 18 met the study criteria.

RESULTS

Almost all of the included studies (n = 16) measured multiple types of victimization through self-report. The most common types of victimization measured were sexual abuse (n = 15), physical abuse (n = 14), and physical neglect (n = 11). Half of studies (n = 9) measured at least one non-maltreatment victimization experience, such as community violence exposure and/or dating violence. However, included studies rarely measured other aspects of victimization, such as timing of exposure (e.g., pre or during foster care), which research has identified as relevant to outcomes.

CONCLUSIONS

This is the first systematic review to assess the measurement of self-reported polyvictimization in research with current or former foster youth. Given the limited comprehensive assessment of victimization, these findings support strong recommendations for developing or adapting polyvictimization measures specifically for foster youth so that the measures include child welfare-specific factors such as the timing and perpetration of victimization experiences.

Perspective matters: Differences between child- and caregiver-reports of emotion regulation mediating the relationship between cumulative childhood trauma and mental health problems in foster children

BACKGROUND

Cumulative childhood trauma predicts mental health problems in children, mediated by emotion regulation (ER). To assess trauma history and mental health in children, different informants may be addressed, assessing data from different perspectives. Despite differences between child- and caregiver-reports as robust finding in child psychology, it remains unclear to which extent perspective matters when examining these variables and related associations.

OBJECTIVE

The current study was set to (1) examine whether ER mediates the relationship between cumulative childhood trauma and mental health problems in children, (2) test whether results differ with examined perspective, and (3) investigate if meaningful patterns of child-caregiver-reported discrepancies can be identified.

METHODS

Data were collected from 145 children living in foster care by child- and caregiver-reports using standardized measures to assess trauma history (CTQ), ER (FEEL-KJ), and mental health problems (CBCL). Mediation and latent profile analysis were calculated.

RESULTS

Mediation analysis identified ER as mediator for internalizing and externalizing mental health problems. Using data from different perspectives, mediation models differed considerably regarding significance, direction, and magnitude of effects. Using latent profile analysis, meaningful patterns of child-caregiver-reported discrepancies were identified and associated with children's sociodemographic and psychopathological characteristics.

CONCLUSIONS

Adaptive and maladaptive ER distinctively mediate the relationship between cumulative childhood trauma and mental health problems in children. Perspective matters when examining these variables and child- and caregiver-reports are not interchangeable. Practitioners and researchers should be aware of inherent limitations when using data from distinct perspectives. Informant discrepancies can carry meaning and should not be ignored, but examined and interpreted instead.

Moderating the Risk for Attention Deficits in Children with Pre-Adoptive Adversity: The Protective Role of Shorter Duration of out of Home Placement and Children's Enhanced Error Monitoring

Early institutional-deprivation has been found to increase risk for inattention/hyperactivity (ADHD). Notably, studies suggest that children with a history of adversity evidencing an enhanced ERP (the error-related-negativity; ERN) may be protected against attention problems. However, such protective effects of the ERN have been studied in children whom typically experienced residential instability. It is unknown whether error-monitoring is similarly protective for children with stable post-deprivation placements. The present study examined the protective effect of the ERN in a sample of children who experienced at least 3-years of stable, relatively enriched caregiving after being internationally-adopted as infants/toddlers from institutional-care. We included two groups of children adopted internationally before age three, one group adopted from institutional-care (PI:n = 80) and one comparison group adopted from foster-care (FC;n = 44). A second comparison group consisted of non-adopted children (NA;n = 48) from demographically comparable families. At five-years of age, we assessed child ADHD symptoms (parent-report) and behavioral performance and neural correlates of error-monitoring (Go/No-Go task). PI children displayed lower Go/No-Go accuracy relative to FC children, and higher levels of ADHD symptoms relative to NA controls. In both FC and PI groups, longer duration of pre-adoptive out-of-home placement was associated with inattention, especially for children with deficits in error-monitoring. Enhancing cognitive control in the form of error monitoring might be a useful intervention target to protect children from some of the negative outcomes associated with adverse early care. Furthermore, results underscore that regardless of type of pre-adoptive care, we should aim to place children in stable/permanent homes as early as possible.

Potentially traumatic events in foster youth, and association with DSM-5 trauma- and stressor related symptoms

BACKGROUND

In DSM 5, three disorders are related to trauma and/or maltreatment: Post-traumatic Stress Disorder (PTSD), Reactive Attachment Disorder (RAD) and Disinhibited Social Engagement Disorder (DSED) but how these disorders relate to each other and to traumatic events is unknown.

OBJECTIVE

We examined 1. Prevalence of Potentially Traumatic Events (PTEs) and poly-victimization for youths in foster care. 2. Associations between single/multiple PTEs and PTSD, DSED, and the two symptom-clusters that constitute RAD: Failure to seek/accept comfort (RAD A), and Low social-emotional responsiveness/ emotion dysregulation (RAD B).

PARTICIPANTS, SETTING AND METHODS

Foster youth 11-17 years (N = 303) in Norway completed The Child and Adolescent Trauma Screen. Foster parents completed the RAD and DSED Assessment interview.

RESULTS

Foster youth reported experiencing, on average, 3.44 PTEs each (range 0-15, SD 3.33), and 52.9 % reported PTSD symptoms at or above clinical cut off. The PTE sum score was associated with the latent factors PTSD (r = .66, p < 0.001), RAD cluster B symptoms (Low social-emotional responsiveness / emotion dysregulation, r = .28, p < 0.001) and DSED (r = .11, p = 0.046), but not with RAD cluster A symptoms (Failure to seek/accept comfort).

CONCLUSIONS

These findings raise new questions about the nature, mechanisms and timing of development of RAD and DSED. Maltreatment assessment needs to encompass a wide range of PTEs, and consider poly-victimization.

The relationship between cumulative traumatic experiences and ICD-11 post-traumatic symptoms in children and adolescents in foster care: The mediating effect of sense of coherence

BACKGROUND

Children and adolescents in foster care show a high prevalence of cumulative traumatic experiences (CTE), symptoms of posttraumatic stress disorder (PTSD) and symptoms related to disturbances in self-organization (DSO). PTSD and DSO constitute the ICD-11 diagnosis Complex PTSD (CPTSD). Sense of coherence (SOC) has been shown to alleviate the impact of CTE.

OBJECTIVE

This study aimed to investigate the mediating role of SOC in the relationship between CTE, PTSD, and DSO.

PARTICIPANTS AND SETTING

Trauma history (CTE), PTSD, DSO and SOC were assessed in a sample of 140 children and adolescents in foster care aged 10-18 using self-report questionnaires.

METHOD

Mediation analysis determined the direct, indirect and total effect of the mediation of SOC in the relationship between CTE, PTSD and DSO.

RESULTS

The results showed no mediation of SOC in the relationship between CTE and PTSD symptoms (indirect effect of b = -.001, 95 %CI: -.088-.086). However, SOC mediated the relationship between CTE and DSO symptoms (indirect effect b = .128, 95 %CI: 0.045-.211).

CONCLUSIONS

Those results may point to a promotive function of SOC for the overall development and different areas of self-organization, but not for PTSD symptoms. It is possible that the influence of the trauma on symptoms of PTSD is too pervasive for the promotive function of SOC. The present findings strengthen the assumption that PTSD and DSO are separate second-order factors, which characterize different groups of trauma survivors. The present findings are vital to inform tailored prevention and intervention strategies for survivors of early CTE.

Children and Young People "In Care" Participating in a Peer-Mentoring Relationship: An Exploration of Resilience

The aim of this study was to explore how a 1-year peer-mentoring relationship contributed to change in young women "in care." Twenty semistructured, one-to-one interviews were conducted with mentors (n = 11) and mentees (n = 9) recruited from two different London local authorities. Participants' accounts were interpreted through a developmental lens to uncover developmental aspects and locus mechanisms through which transformative change took place. Resilience as a healthy outcome was the result of the dual function the mentoring relationship performed. The mentoring relationship was protective against the risks associated with transitioning to independent living and/or adulthood, and promoted internal assets and competencies whereby the mentees' ability to resist them was enhanced. Establishing a trustworthy connection with a role model promoted developmental domains within mentees.

Validation of ICD-11 PTSD and complex PTSD in foster children using the International Trauma Questionnaire

OBJECTIVE

ICD-11 introduces post-traumatic stress disorder (PTSD) and complex PTSD (CPTSD) as two distinct trauma-related disorders. Using the International Trauma Questionnaire (ITQ) as disorder-specific measure, this study is the first to examine the factorial and construct validity of ICD-11 PTSD, CPTSD and the ITQs' applicability in children.

METHODS

Two hundred and eight Austrian foster children completed a set of standardized measures. Excluding participants who reported not having experienced any kind of trauma, a final sample of 136 children completed the ITQ. Factorial and construct validity of ICD-11 CPTSD and psychometric properties of ITQ scales were assessed by factor analysis and latent class analysis.

RESULTS

Confirmatory factor analysis supported the two-factor higher-order model of ICD-11 CPTSD in children by high factor loadings and excellent model fit. Reliability and regression analysis evidenced psychometric adequacy and discriminant validity of ITQ scales. Latent class analysis substantiated construct validity of ICD-11 CPTSD, identifying a CPTSD (22.8%), PTSD (31.6%) and low symptoms class (45.6%). The CPTSD class showed highest rates of childhood trauma, comorbid psychopathology and functional impairment.

CONCLUSION

Factorial and construct validity of ICD-11 CPTSD was evidenced in children for the first time using precise descriptions of ICD-11 symptom content, supporting the reliability and validity of the ITQ in children.

What is known about the LGBTQ perspective in child welfare services? A scoping review protocol

INTRODUCTION

In previous studies, it is estimated that sexual minorities (eg, lesbian, gay, bisexual, transgender and questioning (LGBTQ) individuals) are overrepresented in the child welfare system. However, the numbers are unclear, and there are limited studies in this field. No systematic review of LGBTQ issues across a broader context (ie, youth, foster parents and service providers) of child welfare services exists. The overall objective of this scoping review is to systematically scope the existing research on LGBTQ issues in the context of child welfare services, including policy, practice, service providers and users' perspectives.

METHODS AND ANALYSIS

The scoping review framework outlined by the Joanna Briggs Institute (JBI) based on previous work by Arksey and O'Malley and Levac and colleagues will guide this review. In addition, the PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation will be used throughout the process. We will search electronic databases (PubMed, EMBASE, PsycINFO, Web of Science and Idunn) and grey literature sources to identify studies that are appropriate for inclusion in this review. Using inclusion and exclusion criteria based on the 'Population-Concept-Context' framework, two researchers will independently screen titles, abstracts and full-text articles considered for inclusion. Any qualitative, quantitative and mixed-method study of LGBTQ issues in the child welfare context will be described and synthesised using a thematic synthesis approach.

ETHICS AND DISSEMINATION

A scoping review is a secondary analysis of published literature and does not require ethics approval. This scoping review is meant to provide an overview of the existing literature, aiming to expand policy-makers' and practitioners' knowledge of LGBTQ issues in a child welfare context and identify research gaps that can be used as a basis for further research. The results will be disseminated through a peer-reviewed publication, a conference presentation and a presentation to the key stakeholders.

"I'm Doing My Part, I Just Need Help From the Community": Intervention Implications of Foster and Adoptive Parents' Experiences Raising Children and Young Adults With FASD

Individuals with fetal alcohol spectrum disorders (FASD) have high rates of health care service utilization. It is vital that health care professionals understand FASD and associated family experiences to strengthen their ability to respond to family needs and tailor family-focused interventions. This study included 24 foster and adoptive parents of children and adults (aged 3-33 years) with FASD. Data were collected via individual interviews and focus groups and analyzed thematically. Consistent with a developmental psychopathology perspective, parents' experiences interacted with the individual (with FASD), family, and broader systems ecological levels. Parents undertook protective actions in an attempt to prevent secondary conditions, support their child and family, and mitigate systems barriers. They also experienced stressors at each level, and stress was increased by protective actions. The overall parenting experience was fueled by a protective parenting attitude. Findings can strengthen family-focused care practices with individuals with FASD and their families and inform novel family interventions.

Placement disruption in foster care: Children's behavior, foster parent support, and parenting experiences

BACKGROUND

The majority of children in foster care 24 months or longer experience three or more placements. Children's behavior problems are a primary contributor to multiple moves, but little is known about how behavior problems and other stressors lead to disruptions. This study focused on foster parents' experiences of parenting a child at risk for moves using the determinants of parenting model (Belsky, 1984) to identify potential correlates of difficult parenting experiences and placement disruption.

OBJECTIVE

To identify factors associated with difficult parenting experiences and placement disruption.

PARTICIPANTS

Foster parents (N = 139) caring for children age 8-14 in long term foster care with a history of two or more moves were randomly selected in a large Midwestern state in the U.S.

METHODS

Participants completed a 90-minute telephone interview (86% response rate). Placement moves were tracked prospectively for two years. Parenting experiences and disruption were analyzed using multiple and logistic regression.

RESULTS

Results support aspects of the determinants of parenting model. Behavior problems, children's risk to others, low support, and stress were significantly associated with more difficult parenting experiences (βs = .28, .22, .18, .19, respectively, ps < .05), and more difficult parenting experiences strongly predicted placement disruption (p < .01). Risk to others also predicted disruption before including parenting experiences, with this association becoming nonsignificant after including parenting experiences. Unexpectedly, African American foster parents had a higher risk for disruption, despite more positive parenting experiences.

CONCLUSIONS

These findings support attending to foster parents' parenting experiences, children's risk to others, social support and stress to better support placements of children at risk for disruption.

Exploring the Relationship Between Foster Care Experiences and HIV Risk Behaviors Among a Sample of Homeless Former Foster Youth

Recent research shows high rates of poor behavioral health outcomes among homeless former foster youth, including increased risk for HIV-risk behaviors. In the current study, data were collected from 184 youth at drop-in centers in Los Angeles using behavioral health questionnaires to explore the relationships between specific aspects of foster care experiences and engagement in HIV-risk behaviors. Results indicated that youth whose first homelessness experience occurred before leaving foster care were significantly more likely to engage in drug use with sex and exchange sex than those whose first homelessness experience occurred after leaving foster care. Intervention services targeting HIV-risk behaviors should consider the aspects of foster care placements that may increase the risk of these behaviors, such as long periods of placement or experiencing homelessness before exiting foster care, as well as those that may decrease the risk of these behaviors, such as exiting placement at an older age.

Receptive Vocabulary Development of Children Placed in Foster Care and Children Who Remained With Birth Parents After Involvement With Child Protective Services

Children who experience maltreatment are more likely than nonmaltreated children to demonstrate deficits in early receptive language skills that negatively impact their later academic achievement, social competence, and behavioral adjustment. It remains unclear whether placement in foster care affects children's early receptive language skills. In the current study, we examined whether children with Child Protective Services (CPS) involvement who were in foster care ( n = 176) had more advanced receptive vocabulary than children with CPS involvement who resided with their birth parents ( n = 144). Results demonstrated that children in foster care had higher receptive vocabulary scores at ages 36 and 48 months than children who stayed with their birth parents. Group differences were not significant after controlling for caregiver education level, marital status, and household income. These findings suggest that placement in foster care may be associated with meaningful improvements in children's receptive vocabulary among children with experiences of CPS involvement, and birth parents might benefit from increased supports to promote parent-child interactions that facilitate language development.

Placement in Care in Early Childhood and School Readiness: A Retrospective Cohort Study

The current study examined school readiness for children placed in care of child protection services before age 5. This association was assessed using a population-based cohort of children born in Manitoba, Canada, between 2000 and 2009 ( n = 53,477) and subcohorts of discordant siblings (one sibling taken into care, one sibling not taken into care; n = 809) and discordant cousins ( n = 517). In the population analysis, children placed in care were significantly less likely to be ready for school; this difference was not seen in the discordant sibling or cousin analysis. The findings suggested that differences in school readiness for children placed in care are a result of broader social factors affecting families, not placement into care.

Mental health-related emergency department presentations and hospital admissions in a cohort of urban Aboriginal children and adolescents in New South Wales, Australia: findings from SEARCH

OBJECTIVES

The aim of the current study is to quantify mental health-related emergency department (ED) presentations and hospitalisations, and associated child and family characteristics, in children recruited through four Aboriginal Community Controlled Health Organisations.

SETTING

Four Aboriginal Community Controlled Health Services that deliver primary care. All services were located in urban or large regional centres in New South Wales, Australia.

PARTICIPANTS

1476 Aboriginal children aged 0-17 years at recruitment to the Study of Environment on Aboriginal Resilience and Child Health.

PRIMARY OUTCOME MEASURES

ED presentations and hospital admissions with a primary mental health diagnosis obtained via linkage to population health datasets.

RESULTS

Over a median of 6-year follow-up, there were 96 ED presentations affecting 62 children (10.7/1000 person-years) and 49 hospitalisations affecting 34 children (5.5/1000 person-years) for mental health conditions. Presentations/admissions increased with age. ED presentation was increased with: living in foster versus parental care (adjusted rate ratio (RR)=3.97, 95% CrI 1.26 to 11.80); high versus low baseline child emotional/behavioural problems (adjusted RR=2.93, 95% CrI 1.50 to 6.10); and caregiver chronic health conditions versus none (adjusted RR=2.81, 95% CrI 1.31 to 6.63). Hospitalisations were significantly increased with caregiver unemployment versus home duties (adjusted RR=4.48, 95% CrI 1.26 to 17.94) and caregiver chronic health problems versus none (adjusted RR=3.83, 95% CrI 1.33 to 12.12).

CONCLUSIONS

Tertiary care for mental health issues was relatively common among participating Aboriginal children, with risk elevated for those living in foster care, with prior mental health and behavioural problems and with carers with chronic illness and/or unemployment. While this study suggests high rates of serious mental health events among children from participating communities, the optimum means for reducing these rates, and the need for tertiary care, has not yet been determined. Such information is urgently required to inform policy and programmes to support Aboriginal child and adolescent mental health.

Attachment, Development, and Mental Health in Abused and Neglected Preschool Children in Foster Care: A Meta-Analysis

A proper preparation for foster parents to care for abused and neglected children includes effective training and initial diagnostics in order to plan individual treatment. Hence, a basic knowledge about the main psychosocial and developmental problems associated with abuse and neglect and their prevalence in foster children is needed. For this purpose, a systematical literature review and a series of meta-analyses were conducted. A total of 25 studies reporting data on development ( n = 4,033), mental health ( n = 726), and attachment ( n = 255) of foster children in preschool age met the inclusion criteria. The meta-analyses indicated prevalence rates of approximately 40% for developmental, mental health problems, and insecure attachment. Rates of disorganized attachment were estimated to 22%. These findings outline the necessity of an initial trauma-oriented diagnostics and trainings for foster parents that address foster children's development, mental health, and disorganized attachment.

Dimensions of maltreatment and academic outcomes for youth in foster care

Childhood maltreatment is often associated with youth's ability to successfully function in school. Youth with a history of maltreatment often receive lower grades and scores on tests of academic achievement, as well as demonstrate more negative behaviors in school, as compared to non-maltreated youth. However, there are many inconsistencies in previous studies examining the association between maltreatment and academic outcomes in youth. One potential reason for mixed findings within the literature could be a result of how maltreatment is measured and operationalized. The current study examined if the methods used to define and describe maltreatment contribute to the association between maltreatment and academic functioning in youth. Youth in foster care (N = 490, M_age = 13.13[3.09]) were recruited and information on their maltreatment history and academic functioning was obtained from official agencies, school records, and self-reported measures. Using a SEM framework when examining each dimension separately in the same model, results suggested that frequency maltreatment was more predictive of academic behavior, as compared to type and severity. No dimensions were associated with grades and significant findings were only observed for models using self-report data. However, when examined using a measurement model approach, maltreatment as a whole was associated with school behavior, which was found for both self-report and case file measurement models. The findings suggest a need for research on academic functioning to take a comprehensive approach when measuring and defining maltreatment as this may be a more robust and accurate predictor of academic functioning.

Parenting intervention effects on reunification: A randomized trial of PMTO in foster care

Evidence-supported parenting interventions (ESPIs) have expanded into child welfare because a growing research base has demonstrated positive results among children with serious emotional and behavioral problems. Despite a clear federal policy emphasis on reunification, few randomized trials have tested ESPIs with biological families of children in foster care; even fewer studies have investigated the distal outcomes of ESPIs. The aim of the current study was to examine the effects of Parent Management Training, Oregon (PMTO) model on reunification. Children in foster care with emotional and behavioral problems were randomized to in-home PMTO (n = 461) or services as usual (SAU) (n = 457). Cox regression models tested whether children in the PMTO group achieved higher rates of reunification. We applied life tables data for integrals calculations to estimate days saved in foster care. Analyses were conducted as intent-to-treat (ITT), and per protocol analysis (PPA). ITT results showed reunification rates were 6.9% higher for the PMTO group (62.7%) than the SAU group (55.8%) with 151 days saved per typical child. PPA indicated that intervention completion strengthened effects as PMTO completers' reunification rates (69.5%) were 13.7% higher than the SAU group (55.8%), and were 15.3% higher than non-completers (54.2%). Days saved were also greater for completers as compared to the SAU group (299 days) and non-completers (358 days). Overall, findings suggest that an in-home parenting intervention positively affected reunification as delivered to biological parents of children and youth in foster care with serious emotional and behavioral problems. Implications and future considerations for research are discussed.

Educational attainment for youth who were maltreated in adolescence: Investigating the influence of maltreatment type and foster care placement

Decades of research have consistently shown a link between foster care and low rates of high school completion. Despite the overwhelming knowledge surrounding this association, it remains unclear whether the low rates of high school completion are due to placement in foster care or the maltreatment and other contextual factors that foster care youth have experienced. This study examined the extent to which (a) maltreatment type and (b) foster care placement were associated with the educational attainment of 337 maltreated adolescents. Logistic regression analyses were conducted using two waves of data and the ACR dataset of the National Survey of Child and Adolescent Well-Being (NSCAW). After controlling for academic risk factors related to the adolescents (age, race, and gender), their family (household poverty and parental education), and their environment (community environment), neither maltreatment type nor foster care placement status were associated with subsequent high school completion. Overall, only 58% of the maltreated adolescents reported completing their education. That is about 15% less than the national average at the time data were collected for this study. Results, overall, suggest a need for educational supports and interventions for youth who experience maltreatment during their adolescent years, regardless of maltreatment type and foster care placement.

Effects of a school readiness intervention on hypothalamus-pituitary-adrenal axis functioning and school adjustment for children in foster care

Maltreated children in foster care are at high risk for dysregulated hypothalamus-pituitary-adrenal (HPA) axis functioning and educational difficulties. The present study examined the effects of a short-term school readiness intervention on HPA axis functioning in response to the start of kindergarten, a critical transition marking entry to formal schooling, and whether altered HPA axis functioning influenced children's school adjustment. Compared to a foster care comparison group, children in the intervention group showed a steeper diurnal cortisol slope on the first day of school, a pattern previously observed among nonmaltreated children. A steeper first day of school diurnal cortisol slope predicted teacher ratings of better school adjustment (i.e., academic performance, appropriate classroom behaviors, and engagement in learning) in the fall of kindergarten. Furthermore, the children's HPA axis response to the start of school mediated the effect of the intervention on school adjustment. These findings support the potential for ameliorative effects of interventions targeting critical transitional periods, such as the transition of formal schooling. This school readiness intervention appears to influence stress neurobiology, which in turn facilitates positive engagement with the school environment and better school adjustment in children who have experienced significant early adversity.

Protocol for the economic evaluation of a complex intervention to improve the mental health of maltreated infants and children in foster care in the UK (The BeST? services trial)

INTRODUCTION

Children who have experienced abuse and neglect are at increased risk of mental and physical health problems throughout life. This places an enormous burden on individuals, families and society in terms of health services, education, social care and judiciary sectors. Evidence suggests that early intervention can mitigate the negative consequences of child maltreatment, exerting long-term positive effects on the health of maltreated children entering foster care. However, evidence on cost-effectiveness of such complex interventions is limited. This protocol describes the first economic evaluation of its kind in the UK.

METHODS AND ANALYSIS

An economic evaluation alongside the Best Services Trial (BeST?) has been prospectively designed to identify, measure and value key resource and outcome impacts arising from the New Orleans intervention model (NIM) (an infant mental health service) compared with case management (CM) (enhanced social work services as usual). A within-trial economic evaluation and long-term model from a National Health Service/Personal Social Service and a broader societal perspective will be undertaken alongside the National Institute for Health Research (NIHR)-Public Health Research Unit (PHRU)-funded randomised multicentre BeST?. BeST? aims to evaluate NIM compared with CM for maltreated children entering foster care in a UK context. Collection of Paediatric Quality of Life Inventory (PedsQL) and the recent mapping of PedsQL to EuroQol-5-Dimensions (EQ-5D) will facilitate the estimation of quality-adjusted life years specific to the infant population for a cost-utility analysis. Other effectiveness outcomes will be incorporated into a cost-effectiveness analysis (CEA) and cost-consequences analysis (CCA). A long-term economic model and multiple economic evaluation frameworks will provide decision-makers with a comprehensive, multiperspective guide regarding cost-effectiveness of NIM. The long-term population health economic model will be developed to synthesise trial data with routine linked data and key government sector parameters informed by literature. Methods guidance for population health economic evaluation will be adopted (lifetime horizon, 1.5% discount rate for costs and benefits, CCA framework, multisector perspective).

ETHICS AND DISSEMINATION

Ethics approval was obtained by the West of Scotland Ethics Committee. Results of the main trial and economic evaluation will be submitted for publication in a peer-reviewed journal as well as published in the peer-reviewed NIHR journals library (Public Health Research Programme).

TRIAL REGISTRATION NUMBER

NCT02653716; Pre-results.

Role of Social Environmental Protective Factors on Anxiety and Depressive Symptoms Among Midwestern Homeless Youth

We employ a social stress framework, which examines the influence of multiple stressors (e.g., physical abuse, foster care placement) on an individual's ability to function (e.g., mental well-being), to longitudinally examine the effects of stressful life events on mental health and the role of the social environment in this process among 150 homeless youth. Results revealed that numerous stressors, such as physical abuse and running away from home more frequently, were associated with greater depressive symptoms and elevated anxiety. Having mentors and family and friends from home that youth can rely on resulted in more positive social support, which subsequently lowered the risk for depressive symptoms and anxiety at wave 2.

Role of Social Environmental Protective Factors on Anxiety and Depressive Symptoms Among Midwestern Homeless Youth

We employ a social stress framework, which examines the influence of multiple stressors (e.g., physical abuse, foster care placement) on an individual's ability to function (e.g., mental well-being), to longitudinally examine the effects of stressful life events on mental health and the role of the social environment in this process among 150 homeless youth. Results revealed that numerous stressors, such as physical abuse and running away from home more frequently, were associated with greater depressive symptoms and elevated anxiety. Having mentors and family and friends from home that youth can rely on resulted in more positive social support, which subsequently lowered the risk for depressive symptoms and anxiety at wave 2.

Fostering Change

Senate Bill 11, authored by Sen. Charles Schwertner, MD (R-Georgetown), and passed into law, launched a series of major reforms of Texas' troubled foster care system.

The influence of maltreatment history and out-of-home-care on children's language and social skills

This study examined the extent to which maltreatment history and the characteristics of out-of-home care correlated with the language and social skills of maltreated children. Participants in this study were 82 maltreated children aged between 5 and 12 years of age. All children were residing with state-designated carers in out-of-home-care. The children were presented with standardised tests assessing language and social skills. Results showed that the sample performed significantly below the normative mean on both tests. Correlation analyses showed social skills, but not language skills were correlated with aspects of maltreatment history. The education level of the state-designated carer/s was correlated with the children's language skills; higher education level was associated with higher language skills. The study provides evidence that at the group level, language and social skills are poor in maltreated children. However, gains in language skills might be made via the out-of-home-care environment. Improvements in the social skills of maltreated children may require additional support.

Exit Outcomes for Probation-Supervised Youth in Foster Care: An Examination of Past Child Protection Involvement

Research on youth in foster care has focused on those placed for reasons of maltreatment rather than delinquency, yet most states provide foster care services to youth under probation supervision. This analysis generated knowledge about youth in probation-supervised foster care (PSFC) in California by examining the relationship between past child protective services (CPS) involvement and exit type. CPS records were extracted to identify 17-year-old youths in PSFC between 2008 and 2012 ( N = 11,188). The relationship between allegations of maltreatment and exit type was assessed using regression models. Of the PSFC youth, 64.6% had previous allegations of maltreatment and a quarter had been reported at least 6 times. Youth with a history of placement in CPS foster care were more likely to age out relative to achieving permanency in comparison to PSFC youth with no maltreatment history (relative risk ratio = 2.20; 95% confidence interval [1.90, 2.55]). As the number of reports increased, the likelihood of exiting care by aging out increased relative to achieving permanency ( p < .001). The findings suggest a majority of PSFC youth had maltreatment histories, the overlap between CPS and probation was constant, and maltreatment records may characterize youth in PSFC at risk of negative exits from care.

"Every child that is a foster child is marked from the beginning": The home-school communication experiences of foster parents of children with disabilities

This study investigated the perceptions of foster parents of children with disabilities concerning their interactions with school personnel. We conducted semi-structured interviews with 7 foster parents of 6 children with disabilities (age range=5-16). A qualitative analysis of the interviews resulted in the identification of five thematic areas, including foster parent perceptions of: (a) the role of the foster parent, (b) the efficacy of the foster parent in helping the child learn, (c) invitations to involvement from the school (d) invitations to involvement from the child, and (e) foster child experiences in the school system. Marked differences were found in the perceptions of the perceptions in foster parents of elementary and secondary age students. It is clear that foster parents who take on an active role in their child's education experienced positive relationships with their child's school. Foster parents who take a passive role in their partnerships with the schools experienced increased difficulty maintaining motivation to continue in their efforts to increase collaboration and involvement with the schools. They indicated a sense of anger, distrust, and even hostility towards the schools. Based on the findings, recommendations are provided for improving home-school relationships, and addressing obstacles to successful school partnerships with foster families.

The grip of trauma: How trauma disrupts the academic aspirations of foster youth

The academic challenges foster youth encounter during their P-12 education have been widely reported. Yet, despite these challenges, the majority of foster youth desire postsecondary education. What is less known is the reason why so few foster youth alumni who desire a four-year college degree, achieve this goal. For the participants in this four-year longitudinal study, maltreatment, resulting in foster care placement, and the ensuing exposure to the foster care system, resulted in trauma histories and mental health diagnoses. Anxiety, depression, and posttraumatic stress disorder (PTSD), were the most common diagnosis. The participants shared the ways in which these mental health challenges manifested throughout their college education. Of those in the study, almost half successfully graduated from college, a third dropped out, and only two remain enrolled. This study provides a unique and critical insight into the experiences of foster youth, enrolled in a four-year university, by sharing their stories.

Speaking With and Without Words-An Analysis of Foster Children's Expressions and Behaviors That Are Suggestive of Prior Sexual Abuse

This exploratory study reports on foster children's informal self-disclosures of previously unknown histories of sexual abuse. Data were collected from 40 children's files, and an inductive thematic analysis of verbal and behavioral expressions was conducted. Findings suggest that foster children's self-disclosures can be fragmented, spontaneous, narrative, or triggered and often occur during everyday activities in the foster family. The children disclose their past by referring to the perpetrator or the severity of the abuse or by acting out, mostly by reenacting sexual abuse experiences. In addition, some children use childish vocabulary focusing on genitals or sexual acts they were involved in or want to be involved in. Last, some foster children seem to be linguistically challenged to disclose that a female person abused them or that they were forced to reciprocate sexually. This study adds to the understanding of the complex process of child sexual abuse disclosure in the context of foster care.

Trajectories of post-traumatic stress and externalizing psychopathology among maltreated foster care youth: A parallel process latent growth curve model

Few longitudinal studies have analyzed how violence exposure (e.g. child maltreatment, witnessing community violence) influence both externalizing and Post-Traumatic Stress (PTS) symptoms among children in foster care. Data from three waves of the National Survey of Child and Adolescent Well-Being (1999-2007) (NSCAW; National Data Archive on Child Abuse and Neglect, 2002) were analyzed to investigate the change trajectories of both externalizing and PTS symptomatology among children with a substantiated report of child maltreatment by Child Protective Services (CPS) between October 1999 and December 2000. This study uses data collected at three time points: baseline and approximately 18 (Wave 3) and 36 (Wave 4) months post-baseline. The Child Behavior Checklist (CBCL) scale measured externalizing symptoms and the Post Traumatic Stress Disorder section of a version of the Trauma Symptom Checklist for Children (TSCC) provided the measure of current trauma-related symptoms or distress. Analyses were conducted using a parallel process growth curve model with a sample of n=280 maltreated youth between the ages of 8 and 15 following home removal. Findings revealed that initial levels of externalizing and PTS symptomatology were both significantly and positively related and co-develop over time. Externalizing symptom severity remained in the borderline range during the first two years in out-of-home care. Both direct and indirect forms of interpersonal violence exposure were associated with initial level of externalizing symptom and PTS symptom severity, respectively. Taken together, our results suggest an underlying process that links early violence exposure to the co-development and cumulative impact of PTS on externalizing behavior above and beyond experiences of maltreatment. We conclude by discussing the key points of intervention that result from a more nuanced understanding of the longitudinal relationship between PTS and externalizing symptoms and the effect of complex trauma on growth in these symptoms over time.

The predictors of perceived social support among former foster youth

Based on a 5-wave panel survey of 732 foster youth, the current study examined the respective relationships between foster youths' individual characteristics, youths' social connections with individuals and formal institutions, and the development of perceived social support across the transition to adulthood. Several youth characteristics - including self-reported delinquency and attachment insecurity - were found to be statistically significantly associated with perceived social support. Attachment insecurity also appeared to mediate the relationships between social support and several other youth-level characteristics, including prior placement disruptions and placement with relatives. Social connections with different types of individuals - including caregivers, relatives, natural mentors, and romantic partners - were found to be associated with additive increases in perceived social support. However, some types of connections (e.g., romantic partners, natural mentors) appeared to be associated with much larger increases in social support than other connections (e.g., school or employment). Collectively, the findings help inform agencies' efforts to bolster foster youths' social connections as they transition to adulthood.

The crucial role of the micro caregiving environment: Factors associated with attachment styles in alternative care in Chile

The distribution of attachment styles has been shown to differ between groups of children living with their parents and children placed in alternative care (AC), defined as residential or foster. However, this is the first study in Latin America to explore possible factors affecting the quality of attachment in children living in both residential and foster care. Two groups of children (N=57) were compared: one group living in Residential Homes (RC) and the other in Foster Care (FC) in Chile. Children's, caregivers' and structural factors (e.g., child: caregiver ratios) and their links with attachment styles were investigated. The micro caregiving environment (i.e., the specific individual child caregiver relationship), especially the caregivers' engagement, sensitivity, disciplinary control and affection, as well as some structural factors (i.e., child: caregiver ratios), were linked to attachment security in children. Specifically, better emotional caregiving and lower child-caregiver ratios were associated with higher rates of secure attachment. The association between quality of care (as measured by the HOME inventory) and attachment styles seems to be influenced by caregiver relationships (as measured by CCSERSS). Caregiver relationship factors (i.e., affection, engagement and sensitivity) directly impact the quality of the attachment children establish with them while living in AC. However, the relationships that caregivers establish with children under their care can be facilitated by good quality structural factors, particularly child-caregiver ratios.

The role of poly-victimization in predicting differences in foster youths' appraisals

The present article examines the role of poly-victimization (i.e., number of categories of maltreatment experiences and total maltreatment exposure) in predicting differences in appraisals for 272 youth in foster care (ages 8-21). Poly-victimization was hypothesized to be predictive of negative appraisal valence (i.e., interpreting the impact of a stressful life event as being bad/negative) and appraisal rigidity (i.e., interpreting the impact of life events as being consistently positive or negative across different events) above and beyond any single category of maltreatment. Results show a high prevalence of poly-victimization, such that those youth who experience only one form of maltreatment (e.g., physical, sexual, psychological, or neglect) are among the minority of maltreated youth. Additionally, results show that total maltreatment exposure, accounting for not only different categories of maltreatment but also different types or forms of maltreatment within those broader categories, is the most predictive of negative appraisal valence, above and beyond single categories of maltreatment and number of categories of maltreatment experienced. Contrary to the study's hypothesis, neither total exposure nor number of maltreatment categories experienced is significantly predictive of appraisal rigidity above and beyond single categories. Correlations also show that less rigid or more flexible appraisals are associated with more maltreatment experiences than are rigid appraisals. The current study highlights the importance of examining maltreatment from a poly-victimization perspective and begins to explain why some youth have more negative appraisals than others.

Effects of the ABC Intervention on Foster Children's Receptive Vocabulary: Follow-Up Results From a Randomized Clinical Trial

Children with histories of maltreatment and disruptions in care are at elevated risk for impairments in early language development, which contribute to difficulties in other developmental domains across childhood. Given research demonstrating associations between parent responsiveness and children's early language development, we examined whether a parenting intervention administered in infancy improved preschool receptive language skills in children involved with the child welfare system. Attachment and Biobehavioral Catch-up (ABC) is a 10-session intervention that aims to enhance parent-child interactions. The follow-up results of this randomized clinical trial demonstrated that infants who received the ABC intervention ( n = 24) scored significantly higher on a test of receptive vocabulary at age 36 months than infants who received a control intervention ( n = 28). These results provide evidence of the critical role of parental responsiveness in supporting optimal language development among young children with histories of child welfare involvement.

The Impact of Foster Parent Training on Parenting Skills and Child Disruptive Behavior

Children in foster care are at risk for behavioral and emotional problems that require higher levels of care than other children. To meet these needs and reduce placement disruptions, foster parents require effective parenting skills. Although a number of training models have been evaluated, the findings on the efficacy of foster parent training (FPT) are mixed. We conducted a meta-analysis of the FPT outcome research from 1984 to 2014 to develop a clearer understanding of the impact of such trainings. Fifteen samples (16 studies) were identified that investigated the impact of FPT on self-reported parenting skills and knowledge and child problem behaviors. The mean effect size for child disruptive behavior using a random effects model was small but significant at -.20 (95% confidence interval [CI] = [-.39, -.01], Z = 2.05, p < .05), suggesting that, on average, foster parents who were involved in the trainings reported fewer child behavior problems than parents who did not receive the training. The mean effect size for parenting was moderate and significant at .52 (95% CI = [.22, .82], Z = 3.38, p < .05), indicating that, on average, parents in the treatment groups reported higher levels of skills and knowledge following training than did those in the control group. While these results are promising, more research is necessary to investigate the inconsistency in effect sizes across studies.

Tobacco and Other Drug Use among Foster Care Adolescents in West Virginia

OBJECTIVES

This study presents tobacco and other drug use prevalence data from a statewide health screening program of foster care (FC) children in West Virginia, and explores associations with demographic and placement variables.

METHODS

Logistic regression analyses adjusted for age, sex, and body mass index were conducted to determine if placement type and geographic region were associated with tobacco and other drug use among FC adolescents screened in 2012-2013 by the Early Periodic Screening Diagnosis and Treatment (EPSDT), or HealthCheck WV.

RESULTS

One-third of the 12-17 year-olds used tobacco and 24% used other drugs. Results from the logistic regression analyses showed that significant associations between tobacco and drug use and placement variables persisted after controlling for covariates. Adolescents in home placements were significantly less likely to use tobacco (AOR=0.294; 95% CI: 0.196-0.441) or drugs (AOR=0.269; 95%, CI: 0.164-0.443) than those in agency placements. Details of significant regional variations also are presented.

CONCLUSIONS

This study provides evidence of tobacco and drug use in West Virginia's FC adolescents and highlights a need for appropriate interventions for this vulnerable population.

Developmental Outcomes of Foster Children: A Meta-Analytic Comparison With Children From the General Population and Children at Risk Who Remained at Home

Foster care is often preferred to other placement options for children in the child welfare system. However, it is not clear how the developmental outcomes of foster children relate to children in other living arrangements. In this study, a series of meta-analyses are performed to compare the cognitive, adaptive, and behavioral functioning of children placed in foster care (n = 2,305) with children at risk who remained with their biological parents (n = 4,335) and children from the general population (n = 4,971). A systematic literature search in PsycINFO, Medline, ERIC, and ProQuest identified 31 studies suitable for inclusion (N = 11,611). Results showed that foster children had generally lower levels of functioning than children from the general population. No clear differences were found between foster children and children at risk who remained at home, but both groups experienced developmental problems. Improving the quality of foster care and future research to identify which children are best served by either foster care or in-home services are recommended.