"You think lots of love will heal the child, but it requires a lifetime of patience". Foster parents' intrapersonal and interpersonal struggles.

BACKGROUND: Foster parents can be placed under significant demands when caring for foster children with extensive needs. Coming to terms with the challenges they have to face can be a daunting prospect. To examine foster parents' experiences is vital with a view to enhancing their resilience amid sustained demands and improving the professional support offered to them. OBJECTIVE: This study explores foster parents' lived experience of caring for foster children with mental illness and attachment difficulties. PARTICIPANTS AND SETTINGS: Twenty-two foster parents, caring for foster children aged 2-17, were recruited from a mental health clinic providing assessment and treatment to children. METHODS: In this qualitative study, in-depth interviews were conducted and analyzed using a descriptive phenomenological psychological approach. RESULTS: Our analysis revealed four interrelated constituents describing the foster parents' experiences: 1) Wanting to help a child, 2) Adjustments were harder than expected, 3) Sacrifices and suppression of needs, and 4) Commitment and love mixed with ambivalence. CONCLUSION: The findings highlight that being a foster parent for children with mental illness and attachment difficulties demands heightened patience, knowledge and understanding. It also involves a substantial emotional investment. This underscores the importance of addressing feelings of love, shame, and guilt in this context. Balancing the needs of the foster child with the well-being of the foster family can be challenging. Foster parents may need extensive support from professionals who are familiar with their unique circumstances to increase their feeling of self-efficacy and reduce ambivalent feelings regarding their role as caregivers.

Child welfare predictive risk models and legal decision making.

BACKGROUND: Child welfare agencies around the world have experimented with algorithmic predictive modeling as a method to assist in decision making regarding foster child risk, removal and placement. OBJECTIVE: Thus far, all of the predictive risk models have been confined to the employees of the various child welfare agencies at the early removal stages and none have been used by attorneys in legal arguments or by judges in making child welfare legal decisions. This study will show the effects of a predictive model on legal decision making within a child welfare context. PARTICIPANTS AND SETTING: Lawyers, judges and law students with experience in child welfare or juvenile law were recruited to take an online randomized vignette survey. METHODS: The survey consisted of two vignettes describing complex foster child removal and placement legal decisions where participants were exposed to one of three randomized predictive risk model scores. They were then asked follow up questions regarding their decisions to see if the risk models changed their answers. RESULTS: Using structural equation modeling, high predictive model risk scores showed consistent ability to change legal decisions about removal and placement across both vignettes. Medium and low scores, though less consistent, also significantly influenced legal decision making. CONCLUSIONS: Child welfare legal decision making can be affected by the use of a predictive risk model, which has implications for the development and use of these models as well as legal education for attorneys and judges in the field.

Childhood poverty and foster care placement: Implications for practice and policy.

BACKGROUND: About 6 % of US children enter foster care (FC) at some point before age 18. Children living in poverty enter more frequently than non-poor children. Still, it is less clear if specific dimensions of poverty place a child at risk of FC entry. OBJECTIVE: This study aids our understanding of the relationships between poverty and FC entry. PARTICIPANTS AND SETTING: Data were drawn from a large linked administrative data study following low-income and/or children with maltreatment reports at baseline and followed them through 2010 (n = 9382). METHODS: Separate analyses compared low-income children and children reported for maltreatment. Cox regression analyses were used to account for clustering at the tract level. Poverty was measured at birth, receipt of income maintenance (IM) during the study period, and census tract poverty at baseline. RESULTS: The results showed that within a low-income sample, both family poverty and community poverty measures were significant factors in predicting later FC entry. However, when analyses were run comparing children with maltreatment reports with and without baseline AFDC use, the various measures of poverty diminished in impact once the type of maltreatment and report dispositions were controlled. Furthermore, we found that children living in families with more spells on income maintenance were less likely to enter FC. CONCLUSIONS: Results indicate that specific dimensions of poverty during childhood are associated with later FC entry. The lowered risk associated with a number of spells suggests connections between time limits for income assistance and the risk of entering FC.

The role of primary care in improving health outcomes in young foster children.

ABSTRACT: Children removed from their biological families because of abuse, neglect, and/or violence have increased healthcare needs and are susceptible to poor health outcomes compared with children who are not in the child welfare system. Developmental delays occur in about 75% of children in foster care. Up to 80% of children entering out-of-home care have at least one physical health problem and more than 40% experience educational challenges. In most US states, newly removed children are required to have a medical evaluation shortly after placement in a foster or kinship family. The initial evaluation is important for identifying urgent concerns and developing a rapport with children who may not have had regular medical care. In addition, the child's complete social, trauma, and medical history may be unknown because of system barriers such as inconsistent medical care by biological parents, privacy laws protecting records, and unavailability of birth histories and biological parents' medical and psychosocial histories. As a result, a series of visits is required to fully evaluate the child's development and healthcare needs. This article provides guidance for physician associates/assistants who provide care to children in foster care.

State Implementation of Congregate Care Reforms for Children in Foster Care.

OBJECTIVES: The Family First Prevention Services Act (FFPSA) allows states to use federal Title IV-E funds to provide time-limited, clinically appropriate use of congregate care, including Qualified Residential Treatment Programs (QRTPs), for youth in foster care. October 1, 2021 marked the deadline for states to begin implementing these FFPSA congregate care reforms. From June to September 2022, we conducted a mixed-methods study to obtain a baseline understanding of implementation barriers, successes, and recommendations to inform congregate care policy and practice. METHODS: We fielded a national survey with state child welfare agency directors and conducted focus groups with youth with QRTP experiences, child welfare agency administrators, and QRTP executive leaders. We integrated a descriptive analysis of survey data with focus group themes to summarize state implementation progress. RESULTS: A total of 47 states (90%) responded to the survey. Most states reported ongoing congregate care reforms aligned with FFPSA, reducing the use of congregate care and increasing kinship foster care. QRTPs have become the primary congregate care setting. Top implementation barriers concerned workforce resource and capacity constraints, funding, and access to therapeutic foster care models and foster families. Focus group themes converged on the lack of tailored treatment, quality staff, coordinated aftercare, and a need for QRTP outcome evidence. CONCLUSIONS: Early implementation lessons of FFPSA congregate care reforms call for additional funding and technical assistance, oversight of congregate care, professionalization and investment in QRTP staff, youth advisory boards to promote youth-driven treatment, and performance- and outcome-based monitoring of QRTPs.

[Oral language development in maltreated and foster children]. / Le développement du langage oral chez les enfants maltraités et placés.

Language disorders, which are still very poorly detected, are often present in abused children. While the consequences are well known and long-lasting, little is known about the development and specific characteristics of these children, depending on where they were placed, the type of abuse they suffered and the age at which they were placed. This finding led to a review of the literature aimed at better defining the state of knowledge on the subject, for the benefit of better detection and treatment.

Predictors of the rate and course of reactive attachment disorder and disinhibited social engagement disorder symptoms in foster children during the first year of placement.

BACKGROUND: Due to adverse care experiences, foster children are at risk for developing symptoms of reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED). OBJECTIVE: This study investigated the factors influencing rate and course of RAD and DSED symptoms during the first year of placement in long-term foster care. PARTICIPANTS AND SETTING: The sample consisted of 55 foster children aged 1 to 6 years. Measurements were taken at placement as well as 6 and 12 months after placement. METHODS: RAD and DSED symptoms were assessed with the Disturbance of Attachment Interview (DAI). DSED symptoms were also assessed by observation with the Rating of Infant Stranger Engagement (RISE). Foster parents and caseworkers reported on children's preplacement experiences and placement characteristics. RESULTS: RAD symptoms were rare at Wave 1 (5.5 %) and remitted in most children within the first six months of placement, t(54) = 3.06, p = .003. A total of 30.9 % of the foster children presented DSED symptoms according to the DAI, but only 5.5 % of the children according to the RISE. Foster parents reported symptom reduction, t(54) = 3.71, p = .003, while observational data indicated symptom stability. Prior placement in emergency foster care was associated with lower levels of RAD at Wave 1, F(1.62, 80.88) = 7.80, p = .002, while later placed children presented more RAD and DSED symptoms (RRAD2 = 0.07, RDSED2 = 0.08, RRISE2 = 0.12). Psychopathology of the biological parents (RRAD2 = 0.07, RDSED2 = 0.08) and visitation with the biological parents (RRISE2 = 0.14) predicted symptom stability. CONCLUSION: A substantial number of foster children present persistent DSED symptoms indicating a need for evidenced based interventions.

Life-course trajectories of children through the U. S foster care system.

OBJECTIVE: Foster care is surprisingly commonplace in the United States, with more than one in twenty children experiencing placement in their lifetimes. Due to the complexity of foster care (e.g. age at contact, length of stay), we still lack a clear idea of how children move through the child welfare system. We pose the question, "do distinct typologies of system trajectories exist that may be used to inform policy analyses?" METHODS: We used child maltreatment reports and foster care case records for all U.S. children born in FY2006 and placed in care between birth and age 15. Using sequence analysis, we classified child-level system trajectories into distinct clusters. Then, we employed multilevel multinomial regression to explore child and system characteristics associated with each. RESULTS: Three typologies were identified: 1) early-entry-exit, 2) school-age-entry, and 3) late-entry. Early-entry-exit cases typically entered and left foster care before turning three, were frequently adopted, and had little ongoing system contact. School-age-entry children typically entered between ages 5-10, were in care for the shortest amount of time, and mostly exited to reunification. Late-entry children typically entered between ages 9-11, entered with substantial CPS history and remained in care into mid-adolescence. CONCLUSIONS: Our findings provide the first description of foster care trajectories in the US. Both practice and policy formulation can benefit from these empirically supported descriptions. Using such trajectory typologies, researchers can now explore how trajectories may predict wellbeing outcomes. We discuss how the differences among the typologies may inform identification of service needs and outcomes.

Parenting styles and dental caries in Brazilian children and adolescents in foster care.

PURPOSE: This study aimed to analyse parenting styles as a possible factor associated with caries in foster children and adolescents who had been victims of domestic violence. METHODS: The study was carried out in nine foster shelters in Recife, Northeast Brazil, with a sample of 88 participants aged 8 to 17 years old. Data were collected through intraoral examinations to verify deft/DMFT indices, applying the Demandingness and Responsiveness Scales to determine parenting styles. In turn, sociodemographic data were retrieved from records filed at the institutions. Descriptive analysis was performed, with the Mann-Whitney and Kruskal-Wallis tests being used to compare the categories of numerical variables. RESULTS: The mean deft/DMFT was of 3.78 in children (8 and 9 years old) and 1.93 in adolescents (10 years old and older). Overall, the index was of 2.31. Neglect was the main reason for the children's admission to foster care, while neglectful was the most prevalent parenting style. CONCLUSION: Children of indulgent parents had higher caries indices in both deciduous and permanent teeth, while children of authoritative (permanent teeth) and authoritarian parents (deciduous teeth) had the lowest caries indices. However, no significant associations were found between caries and parenting styles.

First evaluation of Eyberg Child Behavior Inventory for foster children in Japan.

BACKGROUND: Behavioral problems of foster children are an important issue for the maintenance of the foster care system, but they have not been adequately studied in Japan. We used the Eyberg Child Behavior Inventory (ECBI) to investigate behavioral problems among foster children and to examine associated factors. METHODS: Twenty-nine foster children and their foster parents and 479 non-foster children and parents were recruited for the foster and control groups, respectively. Both groups underwent statistical comparative analyses using data from their ECBI assessments. The ECBI has two scales: the Intensity Scale quantifies the severity of child behavioral problems, and the Problem Scale captures the caregiver's perceived difficulties handling each behavior. We conducted a retrospective investigation of the background of the foster parent-child pairs to explore potential causal relationships with behavioral problems. RESULTS: The mean intensity score for the foster group was significantly higher than that for the control group (p = 0.001). The mean problem scores for the foster group and the control group were not significantly different (p = 0.79). In the foster group, the retrospective investigation revealed two children with neurological or neurodevelopmental disorders, 17 with histories of abuse, and 10 with other issues. CONCLUSION: Intensity scores showed severe behavioral problems among foster children, perhaps caused by neurological disorders, abuse, parental mental health, or economic hardship. Problem scores showed no significant differences between groups. It can therefore be posited that foster parents might exhibit a more lenient parenting style when dealing with children who have a history of abuse by their biological parents.

Systematic Review of the Evaluation of Foster Care Programs / [Revisión sistemática sobre evaluación de programas de acogimiento familiar]

Objetive: The aim of this study was to conduct an exhaustive synthesis to determine which instruments and variables are most appropriate to evaluate foster care programs (foster, kinship, and professional families). This evaluation includes the children, their foster families, their families of origin, professionals, and foster care technicians. Method: The systematic review included randomized, quasi-randomized, longitudinal, and control group studies aimed at evaluating foster care interventions. Results: A total of 86 studies, 138 assessment instruments, 18 constructs, and 73 independent research teams were identified. Conclusions: (1) although the object of the evaluations was the children, the informants were usually the people in charge of their care; therefore, effort should be made to involve the children in a more participatory way; (2) psychosocial functioning, behavior, and parenting are transversal elements in most evaluations, while quality of life and coping are not sufficiently well incorporated; (3) practical instruments (brief and easy to apply and correct) that are widely used and carry scientific guarantees should be prioritized to ensure the comparability and reliability of the conclusions; and (4) progress should be made in the study of evaluation models for all forms of foster care, including foster, extended, and specialized families.(AU)

Objetivo: El objetivo es realizar una síntesis exhaustiva que contribuya a determinar qué instrumentos y variables son las más adecuadas para evaluar programas de acogimiento familiar (familias extensas, ajenas y profesionalizadas), incluyendo en esta evaluación a los niños, sus familias acogedoras, sus familias de origen y a los profesionales y técnicos del acogimiento familiar. Método: La revisión sistemática incluyó estudios aleatorizados, cuasialeatorizados, longitudinales y con grupo control dirigidos a evaluar intervenciones de acogimiento familiar. Resultados: Se identificaron 86 estudios, 138 instrumentos de evaluación, 18 constructos y 73 equipos de investigación independientes. Conclusiones: (1) aunque el objeto de las evaluaciones sean los niños, habitualmente los informantes son las personas a cargo de sus cuidados, con lo que se debe hacer un esfuerzo por involucrarlos de forma más participativa; (2) el funcionamiento psicosocial, el comportamiento o la parentalidad son elementos transversales en la mayor parte de evaluaciones, sin embargo la calidad de vida y el afrontamiento no están suficientemente bien incorporados; (3) deben priorizarse instrumentos prácticos (breves y fáciles de aplicar y corregir), de amplio uso y con garantías científicas para asegurar la comparabilidad y fiabilidad de las conclusiones; (4) debe avanzarse en la investigación de modelos de evaluación en todas las modalidades de acogimiento familiar, ya sea en familias ajenas, extensas o especializadas.(AU)

Health Differs by Foster Care Eligibility: A Nine-Year Retrospective Observational Study Among Medicaid-Enrolled Children.

OBJECTIVE: This study sought to determine the prevalence and rates of physical, behavioral, and chronic health conditions among Medicaid-enrolled Colorado children by foster care eligibility codes over 9 years. METHODS: This retrospective, population-based study used Colorado's Medicaid administrative data for all enrolled children, aged <19 years old, from July 2011 to August 2020 to determine the period prevalence and rates of physical, behavioral, and chronic health conditions. We identified children in foster care by Medicaid eligibility codes and used the Pediatric Medical Complexity Algorithm version 3.0 to describe health condition outcomes. We report frequencies and percentages by foster care eligibility status, birth year cohort, and sex. RESULTS: Among 1,084,026 children, we identified 34,971 children in the foster cohort. Rates of physical (1105.0 per 100,000 person-months (PMs)) and behavioral health conditions (583.6 per 100,000 PMs) were two to threefold higher among the foster cohort than peers (physical 685.1 per 100,000 PMs; behavioral 212.2 per 100,000 PMs). By birth cohort, rates of behavioral health conditions among children in foster care were up to 8 times greater than peers. The foster cohort had greater prevalence of chronic conditions with (55.2%) and without (38.6%) behavioral health inclusion. CONCLUSIONS: This study provides a broader health assessment among Medicaid-enrolled children and finds condition disparities concentrated among youth in foster care. A more complete understanding of health problems among children in foster care is critical for health, child welfare, and Medicaid systems to improve health outcomes through coordinated and evidence-based interventions, programs, and policies.

Initial Health Outcomes of a Community-Based Collaboration for Children in Foster Care.

Children entering foster care have complex health needs that can persist across the lifespan. Efforts to improve access to primary care services exist; however, few have been tested. This study evaluated the Missoula Foster Child Health Program, a tri-agency, community-based collaboration in Montana, to determine its impact on health outcomes for youth in care. Demographic, health outcome, and child welfare data were collected from 485 children (50 percent male, 50 percent female, aged 0-18). At program admission, children had unmet service needs, lacking a primary care provider (30 percent), a dental provider (58 percent), and required vaccinations (33 percent). Three-quarters of children had at least one health condition, and one-third had a behavioral health concern. Overall, children in the program had significant decreases in physical and behavioral health problems from admission to discharge. Older children and those with fewer placements were more likely to have positive health changes. Data are promising, representing positive health outcomes of a community-based model for children in care.

A desqualificação das histórias (in)familiares: análise discursiva na suspensão e destituição do poder familiar / The disqualification of (unfamilar)family histories: discursive analysis in the suspension and destitution of family power / La descalificación de los relatos (intra)familiares: análisis discursivo en la suspensión y remoción del poder familiar / La disqualification des histoires (non)familières: analyse discursive dans la suspension et la suppression du pouvoir familial

Resumo Este estudo analisou o percurso de quatro famílias, destituídas do poder familiar, pelo Sistema de Garantia de Direitos da Criança e do Adolescente no Brasil. A análise do discurso de orientação psicanalítica foi empregada no corpus de informações de cada caso, compreendido por documentos relativos ao acompanhamento dos casos e entrevistas, realizadas com familiares e agentes institucionais. Os resultados apontam para formações discursivas que naturalizam ações judiciais punitivas de suspensão ou destituição do poder familiar, aplicadas hegemonicamente às famílias pobres, nas quais as mulheres são as principais culpabilizadas pelas falhas na gestão de cuidados. Verifica-se, também, a descontinuidade do acompanhamento, retomado quando há repetição da aplicação dessas medidas protetivas, assumindo a característica sintomática de falha. A escuta dos atores desses processos surge como uma estratégia de retificação subjetiva, ultrapassando práticas prescritivas e normativas, ratificadoras da exclusão e de criminalização da pobreza, particularmente das famílias negras.

Abstract This study analyzes the journey of four families, deprived of family power, by the Child and Adolescent Rights Guarantee System in Brazil. The psychoanalytically discourse analysis was used in the corpus of information of each case, comprised of documents relating to the accompaniment of the cases and interviews, carried out with family members and institutional agents. The results point to discursive formations that naturalizes punitive judicial actions of suspension or destitution of family power, hegemonically applied to poor families, in which women are considered as the main culprits for failures in care management. There is also discontinuity in follow-ups, resumed when the application of these protective measures is repeated, assuming the symptomatic characteristic of failure. Listening to the actors in these processes emerges as a subjective rectification strategy, going beyond prescriptive and normative practices, which ratify exclusion and the criminalization of poverty, particularly of black families.

Resumen Este estudio analizó la historia de cuatro familias, privadas de poder familiar por el Sistema de Garantía de los Derechos del Niño y del Adolescente de Brasil. El análisis del discurso de orientación psicoanalítica se utilizó en el corpus de datos de cada caso, compuesto por documentos relativos al seguimiento de los casos, y entrevistas, realizadas con familiares y agentes institucionales. Los resultados apuntan a formaciones discursivas que naturalizan acciones judiciales punitivas de suspensión o remoción del poder familiar, aplicadas hegemónicamente a familias pobres, en las que las mujeres son las principales culpabilizadas de los fallos en la gestión del cuidado. También existe discontinuidad en el seguimiento, que se reanuda cuando se repite la aplicación de estas medidas protectoras, asumiendo la característica sintomática de fallo. La escucha de los actores de estos procesos es una estrategia de rectificación subjetiva, superando las prácticas prescriptivas y normativas que ratifican la exclusión y criminalizan la pobreza, en especial de las familias negras.

Résumé Cette étude a analysé le parcours de quatre familles, privées de pouvoir familial, par le Système de Garantie des Droits de l'Enfant et de l'Adolescent au Brésil. L'analyse du discours d'orientation psychanalytique a été utilisée dans le corpus d'informations de chaque cas, composé de documents relatifs au suivi des cas et d'entretiens, réalisés avec des membres de la famille et des agents institutionnels. Les résultats indiquent des formations discursives qui naturalisent les actions judiciaires punitives de suspension ou de suppression du pouvoir familial, appliquées de manière hégémonique aux familles pauvres, dans lesquelles les femmes sont considérées les principales responsables des échecs de la gestion des soins. Il existe également une discontinuité dans le suivi, repris lors de la répétition de l'application de ces mesures de protection, assumant le caractère symptomatique de l'échec. L'écoute des acteurs de ces processus apparaît comme une stratégie de rectification subjective, dépassant les pratiques prescriptives et normatives, qui entérinent l'exclusion et la criminalisation de la pauvreté, notamment des familles noires.

Patience with foster children as a major problem for grandparents in the role of kinship carers aged 60 + and the psychosocial determinants of this deficit.

Kinship care represents the most prevalent form of foster care in Poland. Most commonly, the role of kinship carers is taken on by grandparents, who may struggle with various problems, needs and deficits in this role. The aim of this study was to investigate the problem of patience in kinship carers aged 60 + and its impact on deficits in the performance of roles and duties.Methods Seventy-five foster grandparents (63 female, 84%) aged from 61 to 97 years (M = 69,12; SD = 6.22) were investigated in north-western Poland in 2018 and 2019. The study was based on the diagnostic survey method.Results Psychological disposition, functioning, health problems and parental needs and deficits were assessed using standardised psychometric scales and tools self-constructed for this research study. A lack of patience with foster children was reported by 46.7% (n = 35) of the respondents. Patience deficits corresponded with a significantly lower sense of coherence, especially in the manageability domain (p < 0.001) and such stress coping strategies as lower positive reappraisal (p = 0.016) and seeking of emotional support (p = 0.025), as well as a greater tendency for suppression of activities (p = 0.014) and venting of emotions (p = 0.035). Relatively permanent personality traits and general self-efficacy were not differentiated by patience with children.Conclusions The results suggest that patience - so important for biological and foster parents - is related to psychological competencies that can be improved through psychoeducation and skills-training, which may be beneficial for improving foster carers' effectiveness.

A qualitative exploration of the drivers for the transfer of foster children in Gauteng, South Africa.

BACKGROUND: Many children in South Africa are orphaned or subjected to maltreatment, leaving them in need of care and protection. Foster care is one form of alternative care for such children. Retention of foster parents, or foster care placement stability, is one of the many challenges related to foster care, globally and in South Africa. This instability can have an adverse impact on children, and although some research speaks to the problem, the experiences of South African role players regarding this problem have not been documented, to date. To improve foster care retention in South Africa, local, contextualized studies exploring the drivers of foster care placement instability are required. AIM: The aim of this qualitative study was thus to explore designated social workers' (DSWs) and foster parents' experiences about the reasons prompting foster care transfers. PARTICIPANTS AND SETTING: A purposively selected sample of ten foster parents and ten DSWs in the Gauteng province of South Africa took part in the study. METHODS: A descriptive qualitative study was adopted as basis for this study, which entailed thematic analysis of 20 semi-structured interviews. RESULTS: It was found that children's behavioural problems, a shortage of resources, a lack of parenting skills, problematic relationships between foster parents and foster children, and previous traumatic events, led to most foster care transfers. A key finding from this study, which appears not to be evident in previous studies, centres on the critical role played by money, or rather its absence, in contributing to foster care placement instability. CONCLUSIONS: When considered in conjunction with findings emerging from previous studies, our findings underscore the importance of obtaining a contextualized understanding of local, cultural factors at play in foster care delivery. To improve foster care retention in South Africa, which is fraught with challenges not yet reported elsewhere, it is recommended that screening procedures for foster parents be revised, and that allocation of resources to DSWs be prioritized.

Reducing Abuse and Neglect Recurrence Among Young Foster Children Reunified With Their Families.

BACKGROUND AND OBJECTIVES: Child maltreatment (CM) is a recurrent adverse life event known to cause enduring psychiatric impairment throughout life. For young children in protective custody for a first episode of CM, specialized court-coordinated intervention to optimize reunification has shown promise for preventing CM recidivism, with case series documenting short-term successes. METHODS: We tracked 10-year (Nov 2011-March 2022) court re-entry outcomes in a cohort of 272 young children, birth to six years, reunited with their families following placement in protective custody and court referral to the SYNCHRONY Project, a voluntary clinical service providing Incredible YearsTM parenting education, parental psychiatric care, and serial dyadic clinical evaluation to inform medical recommendations on safety for visitation and reunification. Re-entry was operationalized as rereferral to any Missouri Court and proportions compared with contemporaneous State and national data. RESULTS: SYNCHRONY-enrolled/reunified children experienced frequencies of guardianship (22%) and reunification (46%), in keeping with Missouri averages. In these categories, 3.4% and 7.1% respectively were re-referred to the Court over the 10-year follow-up. In care as usual nationally for this age group, the re-referral proportions are 18% (OR 7.5, P < .0001) and 35% (OR 6.1, P < .0001) respectively. In care as usual in Missouri across all ages, the re-referral proportion is 16% (odds ratio [OR] 3.09, P < .0001). CONCLUSIONS: Judicious implementation of evidence-based parenting education, 2-generation psychiatric care, and clinical consultation were associated with marked reduction in court re-entry versus care-as-usual and warrant consideration in intervention standards for young children in foster care.

Co-development of traumatic stress symptoms and externalising behaviour problems among foster children and the effect of complex trauma: a latent growth curve model.

OBJECTIVES: Foster children are disproportionately exposed to complex trauma, which may lead to multifaceted impairments that manifest in comorbid emotional and behavioural problems. As little is known about the interactions between comorbid disorders over time, the present study aims to explore the co-development of traumatic stress (TS) symptoms and externalising behaviour problems (EBP), as well as the influence of complex trauma operationalised as cumulative child maltreatment (CM). SETTING: As part of a 3-year longitudinal study, children from six foster care facilities in Lower Austria were interviewed at three measurement points. PARTICIPANTS: Of, in total, 263 participating children, the data of 124 children aged 10-18 years (M=13.5, 28% female) could be analysed. PRIMARY AND SECONDARY OUTCOME MEASURES: Latent growth curve models were used to examine the co-development of TS symptoms (International Trauma Questionnaire) and EBP (Child Behaviour Checklist) over time; gender, age and cumulative CM (Childhood Trauma Questionnaire) acted as time-invariant covariates. RESULTS: While average TS symptoms decreased over time, EBP remained stable. Findings revealed that the initial severity of EBP was both related to the initial severity of TS symptoms and predictive of their rate of change. Cumulative CM was a significant predictor of initial TS symptoms and EBP even after controlling for age and gender, but not for the rates of change. CONCLUSIONS: Taken together, our results indicate that EBP and TS symptoms are not only cross-sectionally associated but interact with each other over time. Furthermore, an underlying complex trauma could at least partly determine the severity of the two symptom groups. In accordance with a trauma-informed care approach, our study highlights the importance of trauma-specific screening of high-risk children with complex or diffuse symptoms and argues for the benefits of treatments that focus on improving emotion regulation and social skills in addition to addressing trauma.

Psychotropic Medication Prescribing: Youth in Foster Care Compared with Other Medicaid Enrollees.

Objective: To compare the prevalence of psychotropic medication prescriptions among youth in foster care with those among nonfoster youth on Medicaid. Methods: Children ages 1-18 years in a region of a large southern state who were enrolled in their respective Medicaid plan for at least 30 days between 2014 and 2016 and had at least one health care claim were included. Medicaid prescription claims were categorized by class: alpha agonists, anxiolytics, antidepressants, antipsychotics, mood stabilizers, and stimulants. Primary mental health (MH) or developmental disorder (DD) diagnostic groups were identified for each class. Analyses included chi-square tests, t-tests, Wilcoxon sign rank tests, and logistic regression. Results: A total of 388,914 nonfoster and 8426 children in foster care were included. Overall, 8% of nonfoster and 35% of foster youth were dispensed at least one prescription for a psychotropic medication. Prevalence was higher for youth in care within each drug class and, with one exception, across all age groups. Among children prescribed a psychotropic medication, the mean number of drug classes prescribed was 1.4 (SD 0.8) and 2.9 (SD 1.4) for nonfoster and foster youth, respectively (p < 0.000). Except for anxiolytics and mood stabilizers, more children in foster care were prescribed psychotropic medications without an MH or DD diagnosis. Finally, children in foster care experienced 6.8 (95% CI: 6.5-7.2) times higher odds of being prescribed a psychotropic medication than their nonfoster peers, after controlling for age group, gender, and number of mental and developmental diagnoses. Conclusions: Across all age groups, children in foster care on Medicaid were prescribed psychotropic medications disproportionately more than their nonfoster peers on Medicaid. In addition, children in foster care were significantly more likely to be prescribed psychotropic medication absent an MH or DD diagnosis.