Naomi I. Rae-Grant

The mental health of children in foster care : A comparison with community and clinical samples

Objective: To determine whether the psychiatric profile of children in foster care is more similar to clinical or community profiles. Method: Caregiver and teacher ratings of DSM-III-R externalizing and internalizing symptoms were collected for 3 groups of children: children in foster care, children assessed at a childrens mental health centre, and a community sample. Results: Children in foster care approximated the numbers and types of symptoms of the clinical sample. Coming from a family on social assistance, having a parent with a criminal history, and being of the male gender were correlated with higher externalizing and internalizing symptom scores independent of group membership. Group membership accounted for less than 5% of the variance in psychiatric symptom scores. Conclusions: The high symptom burden of children in care is substantially attributable to their high-risk histories, and treatment should be designed with this in mind.

Psychiatric disorders of children "in care": methodology and demographic correlates

This paper examines psychiatric symptoms and disorders in children in the care of a Childrens Aid Society. Youth, caretaker and teacher scores on the Standardized Clinical Information System questionnaire were correlated with demographic and maltreatment data gathered from the files of children from a Childrens Aid Society. Mean externalizing and internalizing scores for the study group were significantly elevated above the norm on the youth, caretaker and teacher reports; externalizing more so than internalizing. Forty-one percent to 63% of the children studied scored in the pathological range for one or more disorders. Conduct disorder was the most common disorder (30% to 50%). Within the study sample, temporary wards and children with a history of having been abused had more elevated scores. The authors conclude that children in foster care have significant psychiatric morbidity reflective of the extreme adversity and maltreatment they have experienced.

Primary prevention: implications for the child psychiatrist.

This paper emphasizes the importance of primary prevention, reviews some of the conceptual underpinnings of the subject, considers promising intervention programs which could be utilized now, discusses the current state of research in the field and suggests roles for the psychiatrist.

Roadblocks and stopgaps. A review of factors obstructing the development of comprehensive child mental health services.

Even under conditions which might be considered ideal for the development of a comprehensive system of services for disturbed children and adolescents (adequate financial resources, good recruitment and training programs and collaboration between different government departments concerned with youth), there are factors which mitigate against the development of a logical service system. Program development is groomed by its historical background, coloured by prevailing societal attitudes toward children and skewed by the existing funding mechanisms. The case records of children and adolescents referred for assistance in residential treatment placement over a five-year period are analysed in terms of previous interventions. It is evident that the multifaceted nature of the family, social, treatment, and educational needs of children are tackled piecemeal; each agency bringing its resources to bear only on one aspect of the childs functioning and extruding the child when its repertoire of child altering behaviour is exhausted or deemed ineffective; at this point referral is made to another agency or system, resulting in a discontinuous, frequently ineffectual series of “helping” efforts. Understanding, modifying and coordinating service development will require interactive planning between all the caring, treatment, and educational systems on behalf of the child population.