Attachment representations and socio-emotional difficulties in alternative care: A comparison between residential, foster and family based children in Chile.

Attachment has been assessed in children living in alternative care (AC) settings, such as Residential Homes (RC) and Foster Care (FC). However, no study has been conducted to compare attachment styles in residential, foster and parental care conducted as usual in the same country at the same point in time. There is also a lack of studies conducted in less developed countries. Therefore, the aim of this study was to compare outcomes for children living in three different types of care in Chile. Three groups of children (N=77), living in (RC), (FC) and with biological parents (PC) were compared. Attachment styles, Indiscriminate Friendliness (IF) and socio-emotional/behavioral difficulties were assessed. Higher rates of secure attachment were observed in the RC group (36.1%) when compared to studies in RC in other countries (mean 18%). However, children in both types of AC were significantly more likely to have insecure and/or disorganized attachment styles than PC children. Higher rates of socio-emotional and behavioral problems were observed in RC (55.6%) and FC (50%) compared to PC (10%). Within type of AC, no significant differences were found, for attachment styles or for socio-emotional/behavioral difficulties, the only difference were the levels of IF, with children in RC having higher levels. As a conclusion, impact of placement in AC can vary between different countries, other factors, rather than only type of AC could better explain differences in attachment security for children. Implications for research and practices are discussed.

The crucial role of the micro caregiving environment: Factors associated with attachment styles in alternative care in Chile.

The distribution of attachment styles has been shown to differ between groups of children living with their parents and children placed in alternative care (AC), defined as residential or foster. However, this is the first study in Latin America to explore possible factors affecting the quality of attachment in children living in both residential and foster care. Two groups of children (N=57) were compared: one group living in Residential Homes (RC) and the other in Foster Care (FC) in Chile. Children's, caregivers' and structural factors (e.g., child: caregiver ratios) and their links with attachment styles were investigated. The micro caregiving environment (i.e., the specific individual child caregiver relationship), especially the caregivers' engagement, sensitivity, disciplinary control and affection, as well as some structural factors (i.e., child: caregiver ratios), were linked to attachment security in children. Specifically, better emotional caregiving and lower child-caregiver ratios were associated with higher rates of secure attachment. The association between quality of care (as measured by the HOME inventory) and attachment styles seems to be influenced by caregiver relationships (as measured by CCSERSS). Caregiver relationship factors (i.e., affection, engagement and sensitivity) directly impact the quality of the attachment children establish with them while living in AC. However, the relationships that caregivers establish with children under their care can be facilitated by good quality structural factors, particularly child-caregiver ratios.

Classes de comportamentos profissionais de pais sociais identificadas em literatura por meio de análise comportamental / Professional behavioral classes of social parents identified in literature through behavioral analysis

O objetivo desta pesquisa foi identificar classes de comportamentos de pais sociais em instituições de acolhimento na modalidade casa lar. Foi realizado procedimento de identificação de classes de comportamentos a partir de análise documental. O procedimento envolveu transcrever trechos de obras que fizessem referência a informações relativas a componentes de comportamentos de pais sociais, completar ou aperfeiçoar a descrição dos componentes identificados, derivar componentes não identificados nas fontes de informação, nomear as classes de comportamento, listar e categorizar as classes de comportamentos. Foram identificados 123 classes de comportamentos, organizadas em 26 classes gerais, as quais foram agrupadas em cinco classes mais gerais: (a) promover o desenvolvimento afetivo e social das crianças e adolescentes; (b) administrar o ambiente doméstico e institucional; (c) promover a saúde e o desenvolvimento físico das crianças e adolescentes; (d) promover a aprendizagem das crianças e adolescentes e; (e) inserir crianças e adolescentes no ambiente institucional. A identificação desses comportamentos possibilitará melhor qualificar e avaliar o trabalho realizado em casas lares

The objective of this research was to identify behaviors of social parents in shelters. A procedure of indirect observation through documents was performed in order to identify classes of behavior. The procedure consisted of selecting and transcribing passages on specialized literature that make reference to components of behavior of social parents, complete or improve the description of the identified components, derive components that were not identified in the sources of information, name the classes of behavior and list and categorize the classes of behaviors. The research resulted in 123 behavioral classes, organized into 26 general classes, which were grouped into five more general classes: (a) to promote the affective and social development of children and teenagers; (b) to manage the domestic and institutional environment; (c) to promote the health and physical development of children and teenagers; (d) to promote the learning of children and teenagers e; (e) to insert children and teenagers in the institutional environment. Identifying these behaviors allows for better qualification and evaluation of the work performed by these parents in shelter home institutions

Classes de comportamentos profissionais de pais sociais identificadas em literatura por meio de análise comportamental / Professional behavioral classes of social parents identified in literature through behavioral analysis

O objetivo desta pesquisa foi identificar classes de comportamentos de pais sociais em insti-tuições de acolhimento na modalidade casa lar. Foi realizado procedimento de identificaçãode classes de comportamentos a partir de análise documental. O procedimento envolveutranscrever trechos de obras que fizessem referência a informações relativas a componentesde comportamentos de pais sociais, completar ou aperfeiçoar a descrição dos componentesidentificados, derivar componentes não identificados nas fontes de informação, nomear asclasses de comportamento, listar e categorizar as classes de comportamentos. Foram identi-ficados 123 classes de comportamentos, organizadas em 26 classes gerais, as quais foramagrupadas em cinco classes mais gerais: (a) promover o desenvolvimento afetivo e social dascrianças e adolescentes; (b) administrar o ambiente doméstico e institucional; (c) promover asaúde e o desenvolvimento físico das crianças e adolescentes; (d) promover a aprendizagemdas crianças e adolescentes e; (e) inserir crianças e adolescentes no ambiente institucional. Aidentificação desses comportamentos possibilitará melhor qualificar e avaliar o trabalho reali-zado em casas lares(AU)

Adverse childhood experiences, mental health, and quality of life of Chilean girls placed in foster care: An exploratory study.

In Latin America, little research has been conducted regarding exposure to adverse childhood experiences (ACEs), mental health, and health-related quality of life (HRQoL) among foster children. This study examined the association between ACEs and mental health, posttraumatic stress disorder (PTSD), and HRQoL in Chilean foster girls relative to age-matched Chilean family girls. Data were obtained from 27 Chilean foster girls and 27 Chilean girls ages 6 to 17 years living in family homes. Standardized self- and proxy-report measures were used. Foster girls reported more ACEs than controls in terms of familial and nonfamilial sexual abuse and both emotional and physical neglect. Girls living in foster care had a significantly higher rate of PTSD, displayed greater behavioral and emotional problems, and reported a lower HRQoL. Analysis confirmed the well-known cumulative risk hypothesis by demonstrating a significant positive association between the number of ACEs and PTSD symptom severity and a significant negative association with HRQoL. Chilean foster girls endured more ACEs that impair mental health and HRQoL than age-matched peers living with their families. These findings have implications for out-of-home care services in Latin America, highlighting the need to implement not only appropriate trauma-focused treatments but also appropriate prevention strategies.

Motor outcomes in children exposed to early psychosocial deprivation.

OBJECTIVES: To determine the effect of psychosocial deprivation early in life on motor development, assess the impact of a foster care intervention on improving motor development, and assess the association between motor and cognitive outcomes in children with a history of institutional care. STUDY DESIGN: In a randomized controlled trial, children living in Romanian institutions were randomly assigned to care as usual in the institution or placed in family-centered foster care as part of the Bucharest Early Intervention Project. The average age at placement into foster care was 23 months. At age 8 years, the Bruininks-Oseretsky Test of Motor Proficiency, Second Edition, Short Form (BOT2-SF) was applied to assess the motor proficiency of children in both groups, as well as a never-institutionalized group from the Romanian community. RESULTS: Children in the never-institutionalized group did significantly better on the BOT2-SF than children who had ever been institutionalized (P < .001). There was no significant difference in performance between children in the care as usual group and the foster care group. This finding also held true for all individual items on the BOT2-SF except sit-ups. Regression analyses revealed that the between-group and within-group differences in BOT2-SF scores were largely mediated by IQ. CONCLUSION: Early deprivation had a negative effect on motor development that was not resolved by placement in foster care. This effect was predominantly mediated by IQ. This study highlights the importance of monitoring for and addressing motor delays in children with a history of institutionalization, particularly those children with low IQ.

Comparative analysis of the frequency of lower urinary tract dysfunction among institutionalised and non-institutionalised children.

OBJECTIVES: To evaluate the level of symptoms of lower urinary tract dysfunction (LUTD) in orphans in institutions, and compare these data with schoolchildren of the same age group who were not institutionalised, as LUTD in children is related to factors such as social isolation and low self-esteem, with other psychological changes also being cited, although it is unknown whether these problems are primary or secondary to the symptoms of LUTD. PATIENTS AND METHODS: Children institutionalised in orphanages with no parental presence and who are isolated from a family environment are probably more sensitive to psychological disturbances. Psychological changes have been associated with symptoms of urgency and urinary incontinence. Thus 89 orphans were compared with 143 schoolchildren not in institutions. A questionnaire was devised and completed by the care-taking staff in the orphanage, while for the schoolchildren the parents completed the questionnaire. The mean age in the institutionalised children was 7.9 years and that of the control group 7.8 years (P = 0.32). Thirty-nine (44%) of the orphans were boys, vs 74 (54%) of the control group (P = 0.17). RESULTS: The incidence of urgency, diurnal urinary incontinence, nocturnal enuresis and constipation in the orphans and in the control group were: 45 (51%) and 57 (40) (P = 0.17), 36 (40%) and 19 (13%) (P < 0.001), 39 (47%) and 38 (27%) (P = 0.002), and 27 (30%) and 43 (30%) (P = 0.76), respectively. CONCLUSION: Children living in orphanages have a significantly higher level of diurnal urinary incontinence and nocturnal enuresis than those not in an institution.

Influencia del ambiente familiar sobre el crecimiento en niños con privación social

La existencia de una familia que provea las necesidades biológicas y afectivas es una condición básica para el crecimiento y desarrollo normales. La alimentación y los cuidados especiales recibidos en el hospital permitieron la recuperación del peso para talla pero no facilitaron el normal crecimiento en talla de niños abandonados. El ambiente de la familia adoptiva permitió la aceleración del crecimiento en talla y la expresión del potencial genético

Folk-healing among Mexican-American families as a consideration in the delivery of child welfare and child health care services.

If practitioners in cross-cultural services do not understand traditional health beliefs and practices and find ways to incorporate a compatible approach to them in their work, their clients and patients will go their own ways, sometimes with dire results. Practices among Mexican-American families are described.

Impact of legal intervention on sexually abused children.

OBJECTIVE: Examining the psychologic risks of court and related interventions on child sexual abuse victims. DESIGN: A prospective cohort study with follow-up at 5 months. SETTING: Eleven county social service departments in central North Carolina. SUBJECTS: 100 sexually abused children, ages 6 to 17 years, were recruited from consecutive referrals by social service departments; 75 completed the study. MEASUREMENTS AND RESULTS: Using a structured psychiatric inventory, the Child Assessment Schedule, we found a high degree of distress at referral. The level of distress fell by 26% over the next 5 months (p less than 0.001). The 33 children not involved in criminal proceedings improved 30%, in comparison with a 17% improvement in the 22 children waiting for the proceedings (p = 0.042). The 12 children who had testified in juvenile court improved 42% on the Anxiety subscale, in comparison with a 17% improvement in all other subjects (p less than 0.01). With mathematical modeling that controlled for the factors of vaginal or anal penetration, the relationship to the perpetrator, an estimate of verbal IQ, duration of abuse, and whether counseling was received, it was estimated that children waiting for court proceedings at the follow-up examination were only one twelfth as likely to have improved by one standard deviation on the Depression subscale (p less than 0.05). A second model revealed that children who testified in juvenile court were 20.11 times more likely to improve by one standard deviation on the CAS Anxiety subscale (p less than 0.05). CONCLUSIONS: Testimony in juvenile court may be beneficial for the child, whereas protracted criminal proceedings may have an adverse effect on the mental health of the victim.