Peter J. Pecora

Effects of enhanced foster care on the long-term physical and mental health of foster care alumni

CONTEXT Child maltreatment is a significant risk factor for adult mental disorders and physical illnesses. Although the child welfare system routinely places severely abused and/or neglected children in foster care, no controlled studies exist to determine the effectiveness of this intervention in improving the long-term health of maltreated youth. OBJECTIVE To present results of the first quasi-experimental study, to our knowledge, to evaluate the effects of expanded foster care treatment on the mental and physical health of adult foster care alumni. DESIGN We used a quasi-experimental design to compare adult outcomes of alumni of a model private foster care program and 2 public programs. The latter alumni were eligible for but not selected by the private program because of limited openings. Propensity score weights based on intake records were adjusted for preplacement between-sample differences. Personal interviews administered 1 to 13 years after leaving foster care assessed the mental and physical health of alumni. SETTING/ PARTICIPANTS A representative sample of 479 adult foster care alumni who were placed in foster care as adolescents (14-18 years of age) between January 1, 1989, and September 30, 1998, in private (n = 111) or public (n = 368) foster care programs in Oregon and Washington. More than 80% of alumni were traced, and 92.2% of those traced were interviewed. INTERVENTION Caseworkers in the model program had higher levels of education and salaries, lower caseloads, and access to a wider range of ancillary services (eg, mental health counseling, tutoring, and summer camps) than caseworkers in the public programs. Youth in the model program were in foster care more than 2 years longer than those in the public programs. RESULTS Private program alumni had significantly fewer mental disorders (major depression, anxiety disorders, and substance use disorders), ulcers, and cardiometabolic disorders, but more respiratory disorders, than did public program alumni. CONCLUSION Public sector investment in higher-quality foster care services could substantially improve the long-term mental and physical health of foster care alumni.

Children Placed in Long-Term Foster Care: An Intake Profile Using the Child Behavior Checklist/4-18

Foster-care programs are beginning to use standardized assessment methods consistently as part of pro gram and case planning, as well as for documenting the clinical status of children in care. A number o studies have now been published that describe the psychosocial functioning of children in foster care using the Child Behavior Checklist (CBCL). This article reports findings on intake CBCL scores for a group of children 4 to 18 years old served in long-term family foster care by The Casey Family Program an agency serving children in 13 states.These CBCL scores are compared with scores reported for other samples of children in family foster care and residential treatment. Overall rates of serious behavior prob lems for children in care are estimated from the available data.The implications of the findings for clinical and program planning and future research using the CBCL are discussed.

Depression Among Alumni of Foster Care: Decreasing Rates Through Improvement of Experiences in Care

The Northwest Foster Care Alumni Study examined the relation between experiences in foster care and depression among young adults who spent at least a year in foster care as adolescents. Results indicate that preparation for leaving foster care, nurturing supports from the foster family, school stability, access to tutoring, access to therapeutic service and support, and a shorter and more stable placement history were associated with a lower probability of depression in young adulthood. Results provide evidence that suggest ways to improve practice to decrease rates of depression among alumni of care.

Reshaping Child Welfare's Response to Trauma: Assessment, Evidence-Based Intervention, and New Research Perspectives.

Growing evidence has linked early trauma with severe psychiatric consequences. Posttraumatic stress disorder (PTSD) is a potentially debilitating mental health condition found among some youth in foster care and foster care alumni. However, the current child welfare practice response has not met the demands in both assessment and intervention. This critical review aims to use the evidence to reshape the child welfare response to trauma in children and adolescents. We begin with research on the psychiatric consequences of child maltreatment and issues related to diagnostic assessment for PTSD. Next, we compare major foster care/alumni studies showing considerably higher rates of PTSD among young foster care recipients and alumni than among nationally comparable groups. To inform practice on childhood trauma, we then summarize current evidence-based interventions showing effectiveness with PTSD. Finally, we address new dimensions, such as gene–environment research, posttraumatic growth, and implications for reshaping child welfare practice and foster care.

Assessing the accuracy of the International Classification of Diseases codes to identify abusive head trauma: a feasibility study

Objective To assess the accuracy of an International Classification of Diseases (ICD) code-based operational case definition for abusive head trauma (AHT). Methods Subjects were children <5 years of age evaluated for AHT by a hospital-based Child Protection Team (CPT) at a tertiary care paediatric hospital with a completely electronic medical record (EMR) system. Subjects were designated as non-AHT traumatic brain injury (TBI) or AHT based on whether the CPT determined that the injuries were due to AHT. The sensitivity and specificity of the ICD-based definition were calculated. Results There were 223 children evaluated for AHT: 117 AHT and 106 non-AHT TBI. The sensitivity and specificity of the ICD-based operational case definition were 92% (95% CI 85.8 to 96.2) and 96% (95% CI 92.3 to 99.7), respectively. All errors in sensitivity and three of the four specificity errors were due to coder error; one specificity error was a physician error. Conclusions In a paediatric tertiary care hospital with an EMR system, the accuracy of an ICD-based case definition for AHT was high. Additional studies are needed to assess the accuracy of this definition in all types of hospitals in which children with AHT are cared for.

Institutional Predictors of Developmental Outcomes Among Racially Diverse Foster Care Alumni

Child welfare practitioners are confronted with the responsibility of relying on best practice to ensure children in foster care transition successfully into adulthood after leaving the foster care system. Yet, despite recent reforms and efforts to address their needs, research clearly shows that foster care alumni are still more likely to experience negative developmental outcomes compared to adults in the general population. The purpose of this study was to better understand how child-serving systems of care adequately prepare racially diverse foster care alumni to thrive. Controlling for gender, age, placement instability, and circumstances of exit from foster care, study findings highlighted salient racial and ethnic differences relative to which factors predicted the odds of mental health, education, and employment outcomes. Implications for developing and implementing culturally sensitive, evidence-based prevention and intervention programs to promote positive developmental outcomes among racially diverse foster care alumni are discussed.

The Relationship Between Homelessness and Mental Health Among Alumni of Foster Care: Results From the Casey Young Adult Survey

This study examined the relationship between history of homelessness and current mental health symptoms associated with post-traumatic stress disorder (PTSD) among 542 alumni of foster care (ages 19, 22, and 25 years). Approximately one in five (19.8%) alumni of foster care experienced homelessness since leaving care, and alumni experienced symptoms of psychological disorders associated with PTSD at rates significantly higher than the general population. Alumni who had experienced homelessness had significantly higher rates of PTSD-related symptoms compared with those who had not experienced homelessness. Rates of mental health symptoms and homelessness among alumni who received foster care are disproportionately and disturbingly high. Better preparation for independent living could assist young adults as they emancipate from care. In addition, access to mental health services should be expanded to include young adults who have left care.

BENEFITS AND COSTS OF INTENSIVE FOSTER CARE SERVICES: THE CASEY FAMILY PROGRAMS COMPARED TO STATE SERVICES

The foster care system attempts to prepare children and youth who have suffered child maltreatment for successful adult lives. This study documents the economic advantages of a privately funded foster care program that provided longer term, more intensive, and more expensive services compared to public programs. The study found significant differences in major adult educational, health, and social outcomes between children placed in the private program and those placed in public programs operated by Oregon and Washington. For the outcomes for which we could find financial data, the estimated present value of the enhanced foster care services exceeded their extra costs. Generalizing to the roughly 100,000 adolescents age 12-17 entering foster care each year, if all of them were to receive the private model of services, the savings for a single cohort of these children could be about

Exploring the Experiences of Lesbian, Gay, Bisexual, and Questioning Adolescents in Foster Care

6.3 billion in 2007 dollars.

Educational and Employment Achievements of American Indian/Alaska Native Alumni of Foster Care

This article is based on the findings from a subset of gender identity and sexual orientation questions from The Casey Field Office Mental Health Study (CFOMH). It aims to contribute the experiences of youth in the care of Casey Family Programs to the increasing body of research on lesbian, gay, bisexual, transgender, or questioning (LGBTQ) youth in foster care, as well as inform future studies in this area. The CFOMH study interviewed 188 adolescents ages 14 to 17 who were receiving foster care services from Casey Family Programs in 2006. The experiences in care of youth who identified as LGBQ (n = 10) are presented in narrative form, along with data from all youth in care (N = 188) regarding their perceptions of the foster care environment for LGBTQ youth. These findings are intended to underscore the need to conduct a larger, more in-depth study of the experiences of LGBTQ youth in foster care and the environment that foster care provides for them.