Improving the mental health of abandoned children: Experiences from a global online intervention.

In today's world of global migration and urbanization, millions of children are separated from parents. Their mental health and future competences as citizens depend on the quality of care from foster parents and group home staff in nonparental care settings. Caregivers are challenged by poor work conditions, too many children, and a lack of knowledge about care for traumatized children. How can our profession match this challenge by upscaling interventions? Digital designs for applications of psychology are growing, recently accelerated by the COVID-19 crisis. From 2008, the author developed a blended learning intervention. In partnerships with nongovernmental organizations and government agencies, care recommendations from an international network of researchers are transformed into start-up seminars for staff, followed by a 6-month online classroom education. Students learn and practice how to train local caregiver groups in attachment-based care, using training sessions developed in local languages, adjusted to culture. At present, the author's Fairstart Foundation educated 500 staff from partners in 26 countries, who have trained the caregivers of some 40,000 children. The theoretical, logistic and technical steps from research to daily caregiver-child practices are described, to inspire discussions of how online designs and international partnerships may benefit underserved populations. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Pediatrician Guidance in Supporting Families of Children Who Are Adopted, Fostered, or in Kinship Care.

The child welfare system strives to provide children and adolescents in foster care with a safe, nurturing environment through kinship and nonkinship foster care placement with the goal of either reunification with birth parents or adoption. Pediatricians can support families who care for children and adolescents who are fostered and adopted while attending to children's medical needs and helping each child attain their developmental potential. Although this report primarily focuses on children in the US child welfare system, private and internationally adopted children often have similar needs.

Exploring placement stability for children in out-of-home care in England: a sequence analysis of longitudinal administrative data.

BACKGROUND: To monitor stability of care, the proportion of children in England who have experienced three or more placements in the preceding 12-month period is published in government statistics. However, these annual snapshots cannot capture the complexity and heterogeneity of children's longitudinal care histories. OBJECTIVE: To describe the stability of care histories from birth to age 18 for children in England using a national administrative social care dataset, the Children Looked After return (CLA). PARTICIPANTS AND SETTING: We analyzed CLA data for a large, representative sample of children born between 1992 and 1994 (N = 16,000). METHODS: Using sequence analysis methods, we identified distinct patterns of stability, based on the number, duration, and timing of care placements throughout childhood. RESULTS: Although care histories were varied, six distinct patterns of stability were evident including; adolescent 1st entries (17.6%), long-term complex care (13.1%) and early intervention (6.9%). Overall, most children (58.4%) had a care history that we classified as shorter term care with an average of 276 days and 2.48 placements in care throughout childhood. Few children (4.0%) had a care history that could be described as long-term stable care. CONCLUSIONS: Longitudinal analyses of administrative data can refine our understanding of how out-of-home care is used as a social care intervention. Sequence analysis is a particularly useful tool for exploring heterogeneous and complex care histories. Considering out-of-home care histories from a life course perspective over the entire childhood period could enable service providers to better understand and address the needs of looked after children.

LGBT youth in foster care and the critical advocacy role of Public Health Nurses.

AIMS AND OBJECTIVES: The purpose of this study was to describe the role of public health nurses working with lesbian, gay, bisexual, and transgender (LGBT) children in foster care in the San Francisco Bay Area. BACKGROUND: LGBT youth are disproportionately represented in foster care and experience poor health and education outcomes. Foster care public health nurses (FCPHN) are in a unique position to address disparities with timely and appropriate referrals and advocate for policy changes. DESIGN: An online survey was developed to describe FCPHN responsibilities in case managing LGBT children. METHOD: In all, 39 FCPHNs completed the survey. RESULTS: Most FCPHN did not know the number of LGBT youth in their caseload and reported that there was no systematic method of collecting this data. Few FCPHN had received training in LGBT health issues. CONCLUSION: This study confirms reports from other studies regarding lack of systematic data collection to deliver appropriate services to LGBT youth. It reports FCPHN lack of training as well as their assessment of the most important needs of this population. RELEVANCE TO CLINICAL PRACTICE: FCPHNs are in a unique position to advocate by promoting gender inclusive forms in child welfare agencies and addressing disparities in access to care.

Transition to adulthood for youth with disabilities who experienced foster care: An ecological approach.

BACKGROUND: Almost 21,000 youth, in the U.S., leave foster care due to "emancipation" each year. Although not well documented for this age group, nearly half of children/youth in foster care receive a disability diagnosis. There is a growing body of literature about the transition to adulthood for youth with disabilities. However, minimal research exists on the transition experiences of youth in foster care who also have a disability. This study intends to help fill this gap in the literature. OBJECTIVE: The purpose of the study was to uncover challenges during the transition to adulthood for youth with disabilities who experienced foster care and elucidate the supports most beneficial in addressing these challenges. PARTICIPANTS AND SETTING: All participants reside in the United States pacific northwest. Seven foster care alumni aged 19-23 and five professionals serving the target population participated in the study. METHODS: We conducted semi-structured interviews with YDFC and a focus group with professionals to understand the process of the transition to adulthood for YDFC. Our findings generated an ecological model useful for transition planning prior to the youth leaving foster care. Within our model we focus on alterable factors to bring intervention points to light. RESULTS: Barriers uncovered included lack of consistent high school graduation requirements, high quality Independent Living Programs, positive relationships and highly skilled professionals; frequent placement changes; and inappropriate disability or mental health diagnosis. CONCLUSIONS: Recommendations include systems improvements; improved intra- and interagency collaboration; and helping youth build and maintain positive relationships.

What is known about the LGBTQ perspective in child welfare services? A scoping review protocol.

INTRODUCTION: In previous studies, it is estimated that sexual minorities (eg, lesbian, gay, bisexual, transgender and questioning (LGBTQ) individuals) are overrepresented in the child welfare system. However, the numbers are unclear, and there are limited studies in this field. No systematic review of LGBTQ issues across a broader context (ie, youth, foster parents and service providers) of child welfare services exists. The overall objective of this scoping review is to systematically scope the existing research on LGBTQ issues in the context of child welfare services, including policy, practice, service providers and users' perspectives. METHODS AND ANALYSIS: The scoping review framework outlined by the Joanna Briggs Institute (JBI) based on previous work by Arksey and O'Malley and Levac and colleagues will guide this review. In addition, the PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation will be used throughout the process. We will search electronic databases (PubMed, EMBASE, PsycINFO, Web of Science and Idunn) and grey literature sources to identify studies that are appropriate for inclusion in this review. Using inclusion and exclusion criteria based on the 'Population-Concept-Context' framework, two researchers will independently screen titles, abstracts and full-text articles considered for inclusion. Any qualitative, quantitative and mixed-method study of LGBTQ issues in the child welfare context will be described and synthesised using a thematic synthesis approach. ETHICS AND DISSEMINATION: A scoping review is a secondary analysis of published literature and does not require ethics approval. This scoping review is meant to provide an overview of the existing literature, aiming to expand policy-makers' and practitioners' knowledge of LGBTQ issues in a child welfare context and identify research gaps that can be used as a basis for further research. The results will be disseminated through a peer-reviewed publication, a conference presentation and a presentation to the key stakeholders.

Mapping the evidence about what works to safely reduce the entry of children and young people into statutory care: a systematic scoping review protocol.

INTRODUCTION: The increasing number of children and young people entering statutory care in the UK is a significant social, health and educational priority. Development of effective approaches to safely reduce this number remains a complex but critical issue. Despite a proliferation in interventions, evidence summaries are limited. The present protocol outlines a scoping review of research evidence to identify what works in safely reducing the number of children and young people (aged ≤18 years) entering statutory social care. The mapping of evidence gaps, clusters and uncertainties will inform the research programme of the newly funded Department for Education's What Works Centre for Children's Social Care. METHODS AND ANALYSIS: The review uses Arksey and O'Malley's scoping review methodology. Electronic database and website searches will identify studies targeting reduction of care entry, reduction of care re-entry and increase in post-care reunification. Supplementary searching techniques will include international expert consultation. Abstracts and full-text studies will be independently screened by two reviewers. Ten per cent of data abstraction will be independently conducted by two reviewers, with the remainder being extracted and then verified by a second reviewer. Descriptive numerical summaries and a thematic qualitative synthesis will be generated. Evidence will be synthesised according to primary outcome, intervention point (mapped across socioecological domains) and the realist EMMIE categorisation of evidence type (Effectiveness; Mechanisms of change; Moderators; Implementation; Economic evaluation). ETHICS AND DISSEMINATION: Outputs will be a conceptual evidence map, a descriptive table quantitatively summarising evidence and a qualitative narrative summary. Results will be disseminated through a peer-reviewed publication, conference presentations, the What Works Centre website, and knowledge translation events with policy-makers and practitioners. Findings will inform the primary research programme of the What Works Centre for Children's Social Care and the subsequent suite of systematic reviews to be conducted by the Centre in this substantive area.

Pharmacists can improve medication management in the vulnerable population of foster care youth.

OBJECTIVE: The objective of this commentary is to recommend that pharmacists take a larger role in medication management for the vulnerable patient population of youth in foster care. To support this objective, it is important to understand (1) what foster care is, (2) the vulnerabilities of youth in foster care, (3) medication use among youth in foster care, and (4) how the foster care system complicates medication management. SUMMARY: Foster care youth are not yet considered a vulnerable patient population from the pharmacy perspective, despite a high rate of prescriptions and medications without proper indication. By virtue of being removed from their homes, foster youth experience trauma and are placed into a system that can be inconsistent, lead to further disruption, and create gaps in their medical care and management. Despite federal mandates, foster youth medication use remains drastically higher than that of the general population. Pharmacists' skills in medication therapy management, medication reconciliation, patient and caregiver education, and interprofessional collaboration can and should be used to reduce overmedication in the foster care population. CONCLUSION: Pharmacists can provide valuable therapeutic services and bring increased attention to the medication needs of foster care patients by assuming a more active role as a member of their care team.

Providing sex and relationships education for looked-after children: a qualitative exploration of how personal and institutional factors promote or limit the experience of role ambiguity, conflict and overload among caregivers.

OBJECTIVES: To explore how personal and institutional factors promote or limit caregivers promoting sexual health and relationships (SHR) among looked-after children (LAC). In so doing, develop existing research dominated by atheoretical accounts of the facilitators and barriers of SHR promotion in care settings. DESIGN: Qualitative semistructured interview study. SETTING: UK social services, residential children's homes and foster care. PARTICIPANTS: 22 caregivers of LAC, including 9 foster carers, 8 residential carers and 5 social workers; half of whom had received SHR training. METHODS: In-depth interviews explored barriers/facilitators to SHR discussions, and how these shaped caregivers' experiences of discussing SHR with LAC. Data were systematically analysed using predetermined research questions and themes identified from reading transcripts. Role theory was used to explore caregivers' understanding of their role. RESULTS: SHR policies clarified role expectations and increased acceptability of discussing SHR. Training increased knowledge and confidence, and supported caregivers to reflect on how personally held values impacted practice. Identified training gaps were how to: (1) Discuss SHR with LAC demonstrating problematic sexual behaviours. (2) Record the SHR discussions that had occurred in LAC's health plans. Contrary to previous findings, caregivers regularly discussed SHR with LAC. Competing demands on time resulted in prioritisation of discussions for sexually active LAC and those 'at risk' of sexual exploitation/harm. Interagency working addressed gaps in SHR provision. SHR discussions placed emotional burdens on caregivers. Caregivers worried about allegations being made against them by LAC. Managerial/pastoral support and 'safe care' procedures minimised these harms. CONCLUSIONS: While acknowledging the existing level of SHR promotion for LAC there is scope to more firmly embed this into the role of caregivers. Care needs to be taken to avoid role ambiguity and tension when doing so. Providing SHR policies and training, promoting interagency working and providing pastoral support are important steps towards achieving this.

Prevention of psychological distress and promotion of resilience amongst unaccompanied refugee minors in resettlement countries.

AIM: As increasing numbers of unaccompanied refugee minors (URMs) are arriving in Europe, there is a need to investigate which factors promote psychological resilience and improve their mental health. This review aims to identify preventive post settlement influences, including living arrangements, access to mental health services, and effective treatments that may improve mental health outcomes. METHODS: A systematic literature review was conducted of published papers in any language for children (<18 years) entering a host country, unaccompanied and seeking asylum. Specific studies were eligible if they examined any treatment or nontreatment influences on mental health or psychological resilience for the URM. Thirteen published quantitative studies were identified. RESULTS: URMs in more supportive living arrangements including foster care had lower risk of PTSD and lower depressive symptoms compared with those in semi-independent care arrangements. URMs living in reception settings that restricted freedom had more anxiety symptoms. Regarding help seeking, one study found only 30% of URMs had foster parents or guardians who could detect a mental health need. Two papers found the URMs had low levels of contact with mental health services despite the high prevalence of psychiatric symptoms. URMs were less likely than accompanied children to receive trauma-focused interventions, cognitive therapy, or even practical assistance with basic social needs. With regard to treatment evaluation, only case series were identified. Three studies found cognitive behavioural therapy improved PTSD symptoms and mental health outcomes. A less structured approach (mental health counselling alone) did not improve functional health outcomes. CONCLUSION: Higher support living arrangements with low restrictions are associated with lower psychological distress. Most URMs are not receiving psychological interventions, and there is a dearth of studies evaluating treatment effectiveness for this group. There is an urgent need for more research to investigate pathways to mental health services and treatment efficacy in this vulnerable group.

Systematic review of organisation-wide, trauma-informed care models in out-of-home care (OoHC) settings.

Trauma in early childhood has been shown to adversely affect children's social, emotional, and physical development. Children living in out-of-home care (OoHC) have better outcomes when care providers are present for children, physically, psychologically, and emotionally. Unfortunately, the high turnover of out-of-home carers, due to vicarious trauma (frequently resulting in burnout and exhaustion) can result in a child's trauma being re-enacted during their placement in OoHC. Organisation-wide therapeutic care models (encompassing the whole organisation, from the CEO to all workers including administration staff) that are trauma-informed have been developed to respond to the complex issues of abuse and neglect experienced by children who have been placed in OoHC. These models incorporate a range of therapeutic techniques, and provide an overarching approach and common language that is employed across all levels of the organisation. The aim of this study was to investigate the current empirical evidence for organisation-wide, trauma-informed therapeutic care models in OoHC. A systematic review searching leading databases was conducted for evidence of organisation-wide, trauma-informed, out-of-home care studies, between 2002 and 2017. Seven articles were identified covering three organisational models. Three of the articles assessed the Attachment Regulation and Competency framework (ARC), one study assessed the Children and Residential Experiences programme (CARE), and three studies assessed The Sanctuary Model. Risk of bias was high in six of the seven studies. Only limited information was provided on the effectiveness of the models identified through this systematic review, although the evidence did suggest that trauma-informed care models may have significantly positive outcomes for children in OoHC. Future research should focus on evaluating components of trauma-informed care models and assessing the efficacy of the various organisational care models currently available.

An Alternative to Assisted Living and Nursing Homes for Adults: Foster Care.

Foster care programs offer home-like care settings.

Improving Hospital-to-Home Transitions for Children Entering Foster Care.

BACKGROUND AND OBJECTIVES: Hospital-to-home transitions present safety risks for patients. Children discharged with new foster caregivers may be especially vulnerable to poor discharge outcomes. With this study, our objective is to identify differences in discharge quality and outcomes for children discharged from the hospital with new foster caregivers compared with children discharged to their preadmission caregivers. METHODS: Pediatric patients discharged from the Barbara Bush Children's Hospital at Maine Medical Center between January 2014 and May 2017 were eligible for inclusion in this retrospective cohort study. Chart review identified patients discharged with new foster caregivers. These patients were compared with a matched cohort of patients discharged with preadmission caregivers for 5 discharge quality process measures and 2 discharge outcomes. RESULTS: Fifty-six index cases and 165 matched patients were identified. Index cases had worse performance on 4 of 5 discharge process measures, with significantly lower use of discharge readiness checklists (75% vs 92%; P = .004) and teach-back education of discharge instructions for caregivers (63% vs 79%; P = .02). Index cases had twice the odds of misunderstandings needing clarification at the postdischarge call; this difference was not statistically significant (26% vs 13%; P = .07). CONCLUSIONS: Hospital-to-home transition quality measures were less often implemented for children discharged with new foster caregivers than for the cohort of patients discharged with preadmission caregivers. This may lead to increased morbidity, as suggested by more frequent caregiver misunderstandings. Better prospective identification of these patients and enhanced transition improvement efforts targeted at their new caregivers may be warranted.

Evaluation of institutional foster care services for children and adolescents in Recife. / Avaliação dos serviços de acolhimento institucional de crianças e adolescentes no Recife.

This study aimed to evaluate the structure and process of institutional foster care services for the protection of children and adolescents who are victims of neglect and/or violence in Recife. A semi-structured questionnaire was applied to those responsible for the services. Variables frequency were calculated and the following implementation level classification system adopted: critical, when compliance was less than 40% of the recommended standards; inadequate, 40-59%; acceptable, 60%-89%; adequate and excellent, 90-100%. The qualitative analysis consisted in interviews with one manager from the Judiciary and three managers from the Executive. Of the five philanthropic institutions investigated, two had an excellent standard structure; two were acceptable and one inadequate. Among public institutions, one was considered inadequate and the others acceptable. Regarding the process, one institution was found to be excellent and the others acceptable. The content analysis identified that the greatest challenges to introduction of the measures envisaged in the Child and Adolescent Statute are drug use, family geographical remoteness, lack of integration with other institutions and staff turnover.

O objetivo do estudo foi avaliar a estrutura e o processo dos acolhimentos institucionais para proteção de crianças e adolescentes vítimas de abandono e/ou violência no Recife. Foi aplicado um questionário estruturado aos responsáveis pelos serviços, e então calculadas as frequências das variáveis e estabelecida a seguinte classificação do grau de implantação: crítico, quando a adequação à norma preconizada for inferior a 40%; inadequado, de 40-59%; aceitável, de 60%- 89%; adequado e ótimo, de 90-100%. Para análise qualitativa foram realizadas entrevistas com um gestor do poder judiciário e três do executivo. Das cinco instituições filantrópicas, duas apresentaram estrutura padrão ótimo, duas, aceitáveis, e uma, inadequada. Dentre as instituições públicas, uma municipal foi considerada inadequada e as demais, aceitáveis. Com relação ao processo, uma instituição apresentou padrão ótimo e as outras, aceitáveis. A análise de conteúdo permitiu observar que os maiores entraves para a realização das medidas previstas pelo Estatuto da Criança e de Adolescente decorrem do uso de drogas, distanciamento geográfico da família, falta de integração com outras instituições e rotatividade dos profissionais.

Avaliação dos serviços de acolhimento institucional de crianças e adolescentes no Recife / Evaluation of institutional foster care services for children and adolescents in Recife

Resumo O objetivo do estudo foi avaliar a estrutura e o processo dos acolhimentos institucionais para proteção de crianças e adolescentes vítimas de abandono e/ou violência no Recife. Foi aplicado um questionário estruturado aos responsáveis pelos serviços, e então calculadas as frequências das variáveis e estabelecida a seguinte classificação do grau de implantação: crítico, quando a adequação à norma preconizada for inferior a 40%; inadequado, de 40-59%; aceitável, de 60%- 89%; adequado e ótimo, de 90-100%. Para análise qualitativa foram realizadas entrevistas com um gestor do poder judiciário e três do executivo. Das cinco instituições filantrópicas, duas apresentaram estrutura padrão ótimo, duas, aceitáveis, e uma, inadequada. Dentre as instituições públicas, uma municipal foi considerada inadequada e as demais, aceitáveis. Com relação ao processo, uma instituição apresentou padrão ótimo e as outras, aceitáveis. A análise de conteúdo permitiu observar que os maiores entraves para a realização das medidas previstas pelo Estatuto da Criança e de Adolescente decorrem do uso de drogas, distanciamento geográfico da família, falta de integração com outras instituições e rotatividade dos profissionais.

Abstract This study aimed to evaluate the structure and process of institutional foster care services for the protection of children and adolescents who are victims of neglect and/or violence in Recife. A semi-structured questionnaire was applied to those responsible for the services. Variables frequency were calculated and the following implementation level classification system adopted: critical, when compliance was less than 40% of the recommended standards; inadequate, 40-59%; acceptable, 60%-89%; adequate and excellent, 90-100%. The qualitative analysis consisted in interviews with one manager from the Judiciary and three managers from the Executive. Of the five philanthropic institutions investigated, two had an excellent standard structure; two were acceptable and one inadequate. Among public institutions, one was considered inadequate and the others acceptable. Regarding the process, one institution was found to be excellent and the others acceptable. The content analysis identified that the greatest challenges to introduction of the measures envisaged in the Child and Adolescent Statute are drug use, family geographical remoteness, lack of integration with other institutions and staff turnover.

Developing a Health Care System for Children in Foster Care.

In 2012, the Comprehensive Health Evaluations for Cincinnati's Kids (CHECK) Center was launched at Cincinnati Children's Hospital Medical Center to provide health care for over 1,000 children placed into foster care each year in the Cincinnati community. This consultation model clinical program was developed because children in foster care have been difficult to manage in the traditional health care setting due to unmet health needs, missing medical records, cumbersome state mandates, and transient and impoverished social settings. This case study describes the history and creation of the CHECK Center, demonstrating the development of a successful foster care health delivery system that is inclusive of all community partners, tailored for the needs and resources of the community, and able to adapt and respond to new information and changing systems.

A Randomized Controlled Trial of Family Finding: A Relative Search and Engagement Intervention for Youth Lingering in Foster Care.

BACKGROUND: Youth who have experienced foster care are at risk of negative outcomes in adulthood. The family finding model aims to promote more positive outcomes by finding and engaging relatives of children in foster care in order to provide options for legal and emotional permanency. OBJECTIVES: The present study tested whether family finding, as implemented in North Carolina from 2008 through 2011, improved child welfare outcomes for youth at risk of emancipating foster care without permanency. RESEARCH DESIGN: A randomized controlled trial evaluation was carried out in nine counties in North Carolina. All children eligible for intervention services between 2008 and 2011 underwent random assignment. Effects were tested with an intent-to-treat design. Outcome data were obtained for all subjects from child welfare administrative data. Additional outcome data for a subset of older youth came from in-person interviews. SUBJECTS: Subjects included 568 children who were in foster care, were 10-17 years old (at time of referral), had no identified permanent placement resource, and had no plan for reunification. MEASURES: The confirmatory outcome was moves to more family-like placements, whether through a step-down in foster care placement or discharge from foster care to legal permanency. RESULTS: No impact on the confirmatory outcome was observed. Findings regarding exploratory impacts are also described; these must be interpreted with caution, given the large number of outcomes compared. CONCLUSIONS: The evaluation failed to find evidence that family finding improves the outcomes of older youth at risk of emancipation from foster care.

Should Clinicians Medicate against Structural Violence? Potential Iatrogenic Risks and the Need for Social Interventions.

This paper examines how a child psychiatrist might approach treatment of aggression in foster care youth. We argue that a multimodal approach is best. Physicians should weigh not only the iatrogenic risks of off-label antipsychotic medications but also the possible consequences of failing to treat complicating social factors at hand. Advocates must address structural violence and failures of imagination in their efforts to improve mental health equity among vulnerable youth.