Racial and Ethnic Disparities in the Physical Health Outcomes of Children in Foster Care: A Systematic Review

Children of color-especially Black and Indigenous children-are disproportionately overrepresented in foster care and experience barriers in accessing services and receiving physical and behavioral healthcare compared to their White counterparts. Although racial disparities in mental health outcomes of children in foster care have been examined systematically, less is known about racial disparities in their physical health outcomes. This systematic review aimed to examine disparities in physical health outcomes (i.e., general health, developmental delays and disability, chronic illness, health-compromising behaviors, all-cause mortality) of children in foster care by their race and ethnicity (PROSPERO ID: CRD42021272072). Systematic literature searches were conducted in PubMed, EMBASE, PsycINFO, CINAHL, Cochrane Library, and Psychology and Behavioral Sciences Collection. Of the 6,102 unique studies identified, 24 met inclusion criteria: peer-reviewed journal article; published from 1991 to 2021; written in English; involved children in the U.S. foster care system; children were primarily in family-based placements; included health outcomes; included children's race and ethnicity; conducted quantitative analyses; and had an observational study design. There was limited evidence to suggest racial disparities among physical health domains examined, in part, due to the small number of studies, variability across study measures and designs, how race and ethnicity were categorized, and how related results were reported. Research that disaggregates results by more nuanced race and ethnicity categories, goes beyond including race and ethnicity as control variables, and uses more robust study designs to understand where racial disparities lie is necessary to inform practice and policy efforts to attain race and health equity in child welfare.

Using SBIRT (Screen, Brief Intervention, and Referral Treatment) Training to Reduce the Stigmatization of Substance Use Disorders Among Students and Practitioners

Negative attitudes and stigmatization of substance-using patients lead to treatment avoidance and poor physical and health outcomes. Research suggests that training in substance use disorders is a vital tool to abate negative attitudes among health workers. The present longitudinal study trained students and experienced practitioners from various disciplines on the evidence-based Screening, Brief Intervention, and Referral to Treatment (SBIRT) model. The study found significant improvements in the attitudes of students-but not practitioners-who were trained during the program. The paper discusses policy and implementation implications to support and complement sustained impact of training on models such as SBIRT.

Examination of the relationship between social support and treatment outcomes in mothers referred by Child Protective Services utilizing the Significant Other Support Scale

Supportive social networks may play an important role in recovery for mothers within the umbrella of Child Protective Services (CPS). However, investigators have yet to assess how the quality of significant other support assists family-based treatment. In this study the influence of significant others was examined in the family-based treatment of 38 mothers who were referred for behavioral treatment by CPS. The Significant Other Support Scale (SOSS) was empirically developed, and subsequently utilized to assess the extent to which participants' significant others were perceived by treatment providers to support the participants' goals during treatment sessions. Results indicated that SOSS scores (but not participant and significant other session attendance) were associated with lower participant child abuse potential and drug use frequency at the conclusion of treatment. There was no relationship found between SOSS scores and participant session attendance. However, there was a positive correlation between SOSS scores and significant other session attendance (r = .489, p < .01). The results of this study suggest the quality of significant other support during treatment sessions in this population of mothers may be more important to improving treatment outcomes than session attendance per se. Future directions are discussed in light of the results.

Predictors of foster parents' satisfaction and intent to continue to foster

OBJECTIVE

The United States General Accounting Office (United States General Accounting Office [USGAO], 1989) report on out-of-home care affirmed that the foster care system is in crisis. To shed light on some factors that influence retention, the study reported here asked "What factors influence the satisfaction of foster parents?" and "What factors influence the intent of licensed foster parents to continue to foster?"

METHOD

A sample of 539 foster parents in eight urban counties in a large Midwestern state completed questionnaires aimed at addressing these questions.

RESULTS

Some of the factors exerting the strongest influence on satisfaction were: feeling competent to handle the children who were placed; wanting to take in children who needed loving parents; no regrets about investment in foster children; foster mother's age; and agency social worker providing information and showing approval for a job well done. An example of factors exerting influence on intent to continue to foster include overall satisfaction, readiness to phone the social worker, number of foster boys in the home, being treated like one needed help oneself, and agency affiliation (private).

CONCLUSIONS

Efforts to increase the supply of foster homes through recruitment is not enough. The support, training, and professional regard given to parents after they have begun the fostering task is of greater need. Based on analysis of the findings, implications for practice, programming, and policy are offered.