Do Peers, Neighborhood Disorder, Religiosity, Spirituality, and Family Support Influence Polysubstance Use Among Older Youth Transitioning from Foster Care?

PURPOSE: Few studies have explored polysubstance use among youths aging out of foster care, despite higher rates of substance misuse for youths exiting foster care than those in the general population. Polysubstance use has been linked to substance use disorders, health problems, cognitive impairment, suicide, and overdose. METHOD: This study investigates understudied risk and protective factors associated with polysubstance use with data from 384 youth who turned 17 years old between December 1, 2001, and June 30, 2003, and were transitioning out of foster care from the Missouri Children's Division. We conducted bivariate analyses with chi-square tests for categorical variables and Analysis of Variance with continuous independent variables. Then we conducted a multinomial logistic regression to explore differences between individuals who used 1 or no substances, individuals who used only alcohol and marijuana, and individuals who used 2 or more substances. RESULTS: Bivariate analyses found that being white, having deviant peers, and living in a more disordered neighborhood were risk factors for polysubstance use. Multinomial logistic regression results found that being white (RR = 6.89, p < .001), having deviant peers (RR = 1.15, p < .001), and living in a more disordered neighborhood (RR = 1.13, p < .05), increased the risk engaging in polysubstance use. DISCUSSION: Similar to findings in other studies, we found that deviant peers and neighborhood disorder increase the risk of polysubstance use, but family support, church attendance, and spirituality were not protective against polysubstance use. CONCLUSION: Interventions should work to reduce deviant peer relationships among foster youth.

Taking outside in, turning inside out: Exploring social dimensions and psychotherapeutic process in the play therapy of a young girl in foster care.

This paper, a collaborative effort, describes the work of A Home Within (AHW), a volunteer community-based organization providing pro-bono long term psychotherapy to current and former foster youth. We provide a brief description of the treatment model, present a report of treatment conducted by an AHW volunteer, and discuss further reflections on the societal context of our psychoanalytically-informed work. In-depth psychotherapeutic process from the treatment of a young girl in a pre-adoptive foster placement elucidates the psychotherapeutic possibilities when a psychoanalytic treatment model is accessible to current and former foster youth, usually deprived of this form of treatment due to overburdened, underfunded community mental health systems in the U.S. Open-ended psychotherapy afforded this traumatized child an unusual opportunity to work through past relational traumas in order to form new and more secure attachment relationships. We reflect further on the case from the vantage points of both the psychotherapeutic process and the greater societal context of this community-based program.

An Integrative Data Analysis of Main and Moderated Crossover Effects of Parent-Mediated Interventions on Depression and Anxiety Symptoms in Youth in Foster Care.

Without preventative intervention, youth with a history of foster care (FC) involvement have a high likelihood of developing depression and anxiety (DA) symptoms. The current study used integrative data analysis to harmonize data across four foster and kinship parent-mediated interventions (and seven randomized control trials) designed to reduce youth externalizing and other problem behaviors to determine if, and for how long, these interventions may have crossover effects on youth DA symptoms. Moderation of intervention effects by youth biological sex, developmental period, number of prior placements, and race/ethnicity was also examined. Youth (N = 1891; 59% female; ages 4 to 18 years) behaviors were assessed via the Child Behavior Checklist, Parent Daily Report, and Eyberg Child Behavior Inventory at baseline, the end of the interventions (4-6 months post baseline), and two follow-up assessments (9-12 months and 18-24 months post baseline), yielding 4830 total youth-by-time assessments. The interventions were effective at reducing DA symptoms at the end of the interventions; however, effects were only sustained for one program at the follow-up assessments. No moderation effects were found. The current study indicates that parent-mediated interventions implemented during childhood or adolescence aimed at reducing externalizing and other problem behaviors had crossover effects on youth DA symptoms at the end of the interventions. Such intervention effects were sustained 12 and 24 months later only for the most at-risk youth involved in the most intensive intervention.

Out-of-home care characteristics associated with childhood educational underachievement, mental disorder, and police contacts in an Australian population sample.

BACKGROUND: Children in out-of-home care (OOHC) are generally at increased risk of health and social adversities compared to their peers. However, the experiences of children in OOHC are not uniform and their associated health and social indices may vary in relation to characteristics of OOHC placements and child protection contact. OBJECTIVE: To examine associations between a range of characteristics of OOHC placements and child protection contact (e.g., number, type, and age of placement) with educational underachievement, mental disorder, and police contact (as a victim, witness, or person of interest) in childhood. PARTICIPANTS AND SETTING: Participants were Australian children drawn from the New South Wales Child Development Study cohort who had been placed in OOHC at least once between the ages of 0-13 years (n = 2082). METHODS: Logistic regression was used to examine prospective associations of OOHC placement and child protection contact characteristics (type of carer, placement instability, duration and frequency of maltreatment, and amount of time in care) with educational underachievement, mental disorder diagnosis and any type of police contact. RESULTS: Placements with foster carers, greater placement instability, longer and more frequent exposure to maltreatment, and longer time spent in care were each associated with greater likelihood of consequences in all domains of functioning. CONCLUSIONS: Children with certain placement characteristics are at higher risk of adverse consequences and should be prioritised for support services. The magnitude of relationships was not uniform across different health and social indices, highlighting the need for holistic, multiagency approaches to support children placed in care.

Call to action: Prioritizing sleep health among US children and youth residing in alternative care settings.

Sleep health is a critical but under-recognized area of concern for the more than 650,000 children served by the US child welfare system each year. While sleep is vital to optimal child health and development, it is likely harmed by the multiple adversities and traumas experienced among children and youth residing in alternative care settings (ie, kinship care, nonrelative foster care, group homes). Children residing in alternative care settings have experienced, at a minimum, the trauma of removal from a biological parent's care and would benefit from holistic, comprehensive care approaches inclusive of sleep health. Furthermore, few studies are currently available to guide practitioners and policymakers in promoting sleep health among these children. In this Call to Action, our goal is to draw attention to the sleep health of children residing in alternative care settings. We highlight the need for a more robust evidence base to address major knowledge gaps and outline concrete steps toward building future promising sleep health-promoting practices and policies supporting children residing in alternative care settings.

Effectiveness of a home-based early cognitive-motor intervention provided in daycare, home care, and foster care settings: Changes in motor development and context affordances.

BACKGROUND: Appropriate opportunities within the context are crucial to affect the motor trajectory positively. OBJECTIVE: To investigate the effectiveness of professional-parental/caregivers' early motor-cognitive intervention on infants' motor development in Daycare (DC), Home Care (HC), and Foster Care (FC). Secondary objectives were to examine if parents and caregivers modified the context to meet the infants' needs and if making modifications was positively associated with infants' development. METHODS: Participants were 176 infants (DC = 48; HC = 58, FC = 70). Infants' were randomly assigned to intervention (IG) or comparison (CG) groups within each context. The Alberta Infant Motor Scale and Affordances in the Daycare and Home Environment for Motor Development were used. A cognitive-motor intervention was provided for infants in the intervention groups; and, a home-based support protocol for all caregivers and parents. RESULTS: IGs showed higher motor scores at post-test than CGs (p values from 0.018 to 0.026) and positive changes were observed from the pre-to-post intervention for all IGs (p ≤ .0001), and for two CGs (DC p ≤ .0001; HC p = .028). Maternal daily care and home opportunities improved for all infants. CONCLUSIONS: Parents/caregivers' protocol combined with the cognitive-motor intervention lead to better motor outcomes and changes in the context for the IGs. Only the parent/caregivers' protocol was not strong to improve CGs motor outcomes, although changes in context were found. Intensive intervention is need for infants living in vulnerability.

Integrative review of the evaluation of additional support programs for care leavers making the transition to adulthood.

PROBLEM: Care leavers face many challenges during their transition to adulthood, such as educational attainment, financial instability, housing problems and relationship problems. Various structured programs and additional support exist to help them make this transition and these provide help before or after they have left care. However, the outcomes of such support programs are fragmented. The aim of this study was to synthesize the empirical evidence of studies that evaluated additional support programs that facilitated the transition of care leavers to adulthood. ELIGIBILITY CRITERIA: Six databases were searched that were published in English in peer-review journals from 2010 to 2019. We reviewed 16 studies related to additional support programs with different methodological designs. SAMPLE: Care leavers' who have left the foster care. RESULTS: There were two different types of programs: single-focused and multiple-focused programs. Half of them provided holistic support. Feedback from care leavers provided practical suggestions for the development of relationships with the staffs and peers, for the development of programs and care leavers own involvement in decision-making. The evaluations showed weak evidence of the effectiveness of housing, employment and educational programs. CONCLUSIONS: The programs were poorly described and heterogenous so that the outcomes could not be compared. It was not possible to provide robust information about their effectiveness. IMPLICATIONS: We need holistic programs which consider care leavers needs and views, and evaluate rigorously the programs by strong study designs, to determine their effectiveness.

Now and Future of Data Sharing : Brain Magnetic Resonance Imaging Repositories / 생물치료정신의학

Over the past decade, practice of sharing brain magnetic resonance imaging (MRI) data is increasing given significance of reproducibility and transparency in human neuroscience. Larger multimodal brain MRI databases are needed for more robust research findings considering potential possibilities of large variability in human neuroscience. There are currently more than tens of thousands of shared brain MRI datasets across multiple conditions and hundreds of neuroimaging studies using multimodality through shared brain MRI data repositories. This article critically reviews aims, procedures, and current state of brain MRI data sharing. This review focuses on projects and research findings using structural and functional MRI open databases and is further divided into T1- and diffusion-weighted images for structural MRI as well as resting-state and task-based functional MRI. The challenges and directions are finally discussed. Advances in brain MRI data sharing will lead to more rapid progression in human neuroscience by fostering effective longitudinal, multi-site, multimodal neuroimaging research.

A Study on the Korean Medicine Education and the Changes in the Traditional Korean Medicine during the Japanese Colonial Era: Focused on the Korean Medicine Training Schools / 의사학

The modern education institutes play an important role in fostering professional talents, reproducing knowledge and studies, and forming the identities of certain academic fields and vocational communities. It is a matter of common knowledge that the absence of an official Korean medicine medical school during the Japanese colonial era was a severely disadvantageous factor in the aspects of academic progress, fostering follow-up personnel, and establishment of social capability. Therefore, the then Korean medicine circle put emphasis on inadequate official education institutes as the main factor behind oppression. Furthermore, as the measure to promote the continuance of Korean medicine, the circle regarded establishing civilian Korean medicine training schools as their long-cherished wish and strived to accomplish the mission even after liberation. This study looked into how the Korean medicine circle during the Japanese colonial era utilized civilian training schools to conduct the Korean medicine education conforming to modern medical school and examined how the operation of these training schools influenced the changes in the traditional Korean medicine. After the introduction of the Western medical science, the Korean medicine circle aimed to improve the quality of Korean medicine doctors by establishing modern Korean medicine medical schools. However, after the annexation of Korea and Japan, official Korean medicine medical schools were not established since policies were organized centered on the Western medical science. In this light, the Korean medicine circle strived to nurture the younger generation of Korean medicine by establishing and operating the civilian Korean medicine training schools after the annexation between Korea and Japan. The schools were limited in terms of scale and status but possessed the forms conforming to the modern medical schools in terms of education system. In other words, the civilian training schools not only adhered to the standard education of Korean medicine but also aimed to lay their foundation in the education system of the Western medical science by forming the separated curriculum including basic medical science, diagnosis, clinic, drug, and the practice of acupuncture and moxibustion. Furthermore, having contained the basic subjects of the Western medical science - physiology, anatomy, pathology, etc. - in the compulsory subjects shows perceiving the intellectual and systematic hegemony of the Western medical science and satisfying the demand of the colonial power. Such an education system was succeeded and solidified through the training sessions and the training schools operated by the local colonial governments after the 1930s. Korean medicine became different from the traditional Korean medicine through the establishment and the operation of such training schools.

Improving outcomes for babies and toddlers in child welfare: A model for infant mental health intervention and collaboration.

Children under three comprise a sizable and growing proportion of foster care placements. Very young children who enter the child welfare system experience disruptions of critical attachments that are essential to this formative stage of brain development, as well as other traumatic events, leaving them at great risk for lifelong impairments. To reverse these concerning outcomes, babies who have been removed from their homes require intensive, relationship-based interventions that promote secure attachment to a primary caregiver and holistic attention the child's developmental needs. Child welfare decision-makers must be informed of infant brain development and knowledgeable about the particular needs and circumstances of each child. This article describes a model with these features that has been developed and tested in the Bronx, New York, one of the nation's poorest urban counties with high rates of foster care. The Project utilizes evidence-based Child-Parent Psychotherapy (CPP) as its core intervention, and emphasizes collaboration and information sharing- driven by the CPP clinician- with judges, child welfare workers, attorneys and other social service and mental health providers, thereby encouraging developmentally and relationally informed case planning and permanency decisions. The model is evaluated using pre and post treatment psychosocial measures and program outcome data. Results indicate improvement in parenting interactions, positive child welfare outcomes (including increased rates of reunification, fewer returns to foster care), and improved safety and wellbeing. Results highlight the need for child welfare practices to be more closely aligned with the current science of infant brain development, and to incorporate a specialized approach to address the unique needs of infants.

Addressing the mental health needs of looked after children in foster care: the experiences of foster carers.

WHAT IS KNOWN ON THE SUBJECT?: In the UK and internationally, the number of looked after children is increasing year on year. Mental health problems among looked after children are significantly higher than in the general population, and the uptake of mental health services for these children is low. There is a poor prognosis for children with untreated mental health problems; this is further compounded if the child is within the care system. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: This study adds to our understanding of foster carers' experiences of the mental health needs of looked after children and demonstrates some of the challenges associated with accessing appropriate and timely mental health services. New knowledge derived from this research is that the barriers to accessing Child and Adolescent Mental Health Services (CAMHS) are not at the time of initial referral as previously reported, but later, once within the mental health system with long waiting times experienced particularly for specialist services. This study provides new insights into the experience of being a foster carer and the levels of support and resources needed that directly relate to the viability of the placement. The majority of the foster carers interviewed were from a Black and Minority Ethnic (BME) background, previously under-represented in this research area. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: A number of areas in current CAMHS provision need addressing with a focus on accessibility, consultation and support for foster carers. Waiting times need to be addressed, and improved communication with other agencies is also highlighted. CAMHS nurses are well placed to develop and deliver a comprehensive care package to foster carers, offering more tailored support to them whilst enabling the children and young people in their care to access and engage more effectively with mental health services. ABSTRACT: Introduction Despite well-documented vulnerabilities to mental health problems among the increasing population of looked after children, there continues to be poor uptake and utilization of Child and Adolescent Mental Health Services (CAMHS). Aim To elicit views of foster carers regarding the mental health needs of children and adolescents in their care and their experiences of accessing mental health services. Methods A grounded theory approach and semistructured interviews with ten foster carers. Results The experience of being a foster carer was the core category, with three major themes: (1) foster carers' psychological understanding of challenging behaviour; (2) barriers to accessing CAMHS; (3) the importance of support. Discussion A key finding of this research is that barriers to accessing CAMHS were not experienced at the point of referral, but once within the mental health system. The foster carers demonstrated a proactive approach to accessing services but expressed a need for more support structures related directly to the viability of the placement. Implications for practice Mental health nurses have a pivotal role in providing a more responsive and needs-led service for this population; professional support to foster carers to include facilitating peer support; and clinical interventions for the looked after children.

Neuro-Physiological Psychotherapy (NPP): The development and application of an integrative, wrap-around service and treatment programme for maltreated children placed in adoptive and foster care placements.

This article describes the development and application of a wrap-around, multidisciplinary, brain-based, developmental and attachment-focussed intervention for children who have experienced significant trauma in the context of their early life. It outlines the presentation of the children and families who are referred to the service and the model of treatment that they receive. In doing so, it identifies the core components underpinning Neuro-Physiological Psychotherapy (NPP) and links the application of the integrative model to research and practice in the field of neuroscience and attachment and to the use of therapeutic approaches that are beneficial to maltreated children and their adoptive parents. It highlights the need for a neuro-sequential approach that impacts all aspects of the child's life in the effort to redress the impact of developmental trauma with the aim of improving their overall functioning and their ability to develop healthy relationships into the future.

Challenges of Assessing Maltreated Children Coming into Foster Care.

Children who have experienced early adversity have been known to be at risk of developing cognitive, attachment, and mental health problems; therefore, it is crucial that children entering foster care can be properly assessed as early as possible. There are known difficulties in assessing children in foster care, for example, in finding a reliable informant. An ongoing randomised controlled trial in Glasgow, Scotland, recruiting infants entering foster care, provides a unique opportunity to explore some of the issues which need to be considered when assessing these children. The assessment data of 70 infants entering care is described while exploring the reliability of foster carers as informants and the importance of infant engagement with tasks. This group of infants was shown to be having more problems than children from the general population. While correlations were found between a carer's level of concern about a child and the severity of a child's problem, there were still a number of children displaying worrying problem scores whom foster carers did not report concern. The child's engagement in the cognitive task showed associations with the child's attainment on the task. Findings emphasise the importance of a holistic assessment for these children and all should be considered as potential cases with Maltreatment-Associated Psychiatric Problems (MAPP).

Medical foster care: what happens when children with medical complexity cannot be cared for by their families?

Medical interventions for life-threatening pediatric conditions often oblige ongoing and complex medical care for survivors. For some children with medical complexity, their caretaking needs outstrip their parents' resources and abilities. When this occurs, the medical foster care system can provide the necessary health care and supervision to permit these children to live outside of hospitals. However, foster children with medical complexity experience extremes of social and medical risk, confounding their prognosis and quality of life beyond that of similar children living with biologic parents. Medical foster parents report inadequate training and preparation, perpetuating these health risks. Further, critical decisions that weigh the benefits and burdens of medical interventions for these children must accommodate complicated relationships involving foster families, caseworkers, biologic families, legal consultants, and clinicians. These variables can delay and undermine coordinated and comprehensive care. To rectify these issues, medical homes and written care plans can promote collaboration between providers, families, and agencies. Pediatricians should receive specialized training to meet the unique needs of this population. National policy and research agendas could target medical and social interventions to reduce the need for medical foster care for children with medical complexity, and to improve its quality for those children who do.

A pilot randomized trial teaching mindfulness-based stress reduction to traumatized youth in foster care.

This article presents a pilot project implementing a mindfulness-based stress reduction program among traumatized youth in foster and kinship care over 10 weeks. Forty-two youth participated in this randomized controlled trial that used a mixed-methods (quantitative, qualitative, and physiologic) evaluation. Youth self-report measuring mental health problems, mindfulness, and stress were lower than anticipated, and the relatively short time-frame to teach these skills to traumatized youth may not have been sufficient to capture significant changes in stress as measured by electrocardiograms. Main themes from qualitative data included expressed competence in managing ongoing stress, enhanced self-awareness, and new strategies to manage stress. We share our experiences and recommendations for future research and practice, including focusing efforts on younger youth, and using community-based participatory research principles to promote engagement and co-learning. CLINICALTRIALS.GOV: Protocol Registration System ID NCT01708291.

Impact of protective factors on resilience of grandparent carers fostering orphans and non-orphans in Zimbabwe.

OBJECTIVE: This study sought to explore the impact of protective factors, health, and well-being on resilience of grandparents fostering orphans. METHOD: Data were collected from grandparents (N = 327; M age = 62.4; SD = 11.2) in Zimbabwe using a survey instrument comprising the Resilience Scale and World Health Organization Quality of Life Questionnaire (WHOQOL-BREF). Data were analyzed using hierarchical regression, predicting resilience from demographics, personal and social assets, health, and well-being. RESULTS: Protective factors associated with resilience were personal assets (high self-esteem, problem-solving skills, and mastery) and social assets (social networks and spirituality). Grandparents with higher coping skills, younger age, and high socioeconomic status (SES) had superior personal competences for resilience than peers with lower self-rated personal attributes. Grandparents with good physical and mental health had higher resilience profiles. DISCUSSION: Positive emotions and good health experienced by resilient grandparent carers function as protective factors to reduce the magnitude of adversity to individuals and assist them to cope well with caregiving.

[Trauma, developmental stages, and motivational abilities in indentured Swiss child laborers in old age]. / Traumata, Entwicklungsperioden und motivationale Fähigkeiten bei Schweizer Verdingkindern im Alter.

OBJECTIVES: The study examined the relationship between potential traumatic events in childhood and motivational abilities in old adulthood according to developmental stage. METHODS: The motivational abilities of self-efficacy, conscientiousness and impulsivity (self control) were investigated in a sample of 114 formerly indentured Swiss child laborers. Adversities were assessed by the Childhood Trauma Questionnaire (CTQ). The sample was split into four age groups according to the beginning of the potential trauma: infancy (0-2), preschool (3-5), early childhood (6-9), and early adolescence (≥ 10). RESULTS: The strongest relationship was found between self-efficacy and CTQ in the group "early adolescence," followed by the relationship between conscientiousness and CTQ in the same group. Impulsivity and CTQ were most strongly associated in the "preschool" group. CONCLUSION: Childhood adversities seem to have a negative impact on self-efficacy and conscientiousness after the age of ten. In contrast, self-control seems to be affected by the deleterious effect of trauma or adversity already at an earlier age.

Residential care for abandoned children and their integration into a family-based setting in Uganda: lessons for policy and programming.

This article describes a model of care for abandoned and neglected infants in need of urgent physical, social, and medical support as implemented by the Child's i Foundation, an international, nongovernmental organization operating in Uganda. The model discounts the need for long-term care of young children within institutions and challenges the basis for intercountry adoption. Underpinned by the essentials of care continuum provided under the Uganda National Alternative Care Framework (Ministry of Gender, Labour and Social Development, 2012), the model emphasizes the need to effect the reintegration of the separated child within the family of his or her birth, or locally organize foster care or adoption. Highlighting policy and programming lessons, the model showcases a holistic approach to the problem and puts emphasis on interventions that are protective, promotional, and transformational and the use of a community-oriented approach. The model offers guidance to both government and nongovernment actors in addressing the problems of child neglect and abandonment through the implementation of the alternative care framework.

Concept Analysis of Developmental Care for Preterm Infants: Hybrid Model

PURPOSE: The purpose of this study was to define and clarify the concept of developmental care for preterm infants. METHODS: The hybrid model method was used to identify the main attributes and indicators. In the field work stage, data were collected in Seoul and Cheonan, Korea. The participants were 5 nurses working in the NICU. RESULTS: The concept of developmental care was found to have six attributes and ten indicators in 2 dimensions. For the nursing practice dimension, four attributes were derived. They were being like intrauterine state, individualization, interaction, and integrative care with awareness of development. For the family centeredness dimension, supporting parental attachment and professional alliance were attributes of developmental care. CONCLUSION: Developmental focused care can facilitate the identification of behavioral responses of newborns and provide individualized interventions for fostering growth and development. This concept analysis could provide guidelines for "developmental care" nursing practice and be useful for research in the neonatal field.