Youth with intellectual and developmental disabilities (I/DD) are more likely to be placed in foster care than other youth. Examining the clinical and sociodemographic characteristics of youth with ...I/DD in the foster care system is critical for identifying disparities and understanding service needs.
To produce a population-level analysis of youth with I/DD in foster care that examines differences in rates of foster care involvement based on race, ethnicity, age, and sex.
This cross-sectional study involved all individuals with I/DD 21 years and younger enrolled in Medicaid through foster care in 2016 via data from Transformed Medicaid Statistical Information System (T-MSIS) Analytic Files (TAF) for all 50 US states and Washington, DC. As a key insurer of I/DD services and foster care, Medicaid claims offer a timely population-level analysis. Youth with I/DD were grouped into diagnostic subgroups: autism spectrum disorder (ASD) only, intellectual disability only, or ASD and ID. The data analysis took place from July 2022 to September 2023.
TAF data contain Medicaid enrollment information by month with a binary indicator of foster care involvement, and eligibility files identify race, ethnicity, age, and sex.
The period prevalence of foster care involvement was determined among I/DD youth by diagnostic subgroups using an intersectional approach across race, ethnicity, age, and sex. Logistic regression examined associations between risk for foster care involvement and race, ethnicity, age, and sex.
A total of 39 143 youth with I/DD had foster care involvement in 2016. Black youth (adjusted odds ratio aOR, 1.37; 95% CI, 1.28-1.47) and females (aOR, 1.18; 95% CI, 1.1-1.27) had increased likelihood for foster care involvement. The likelihood for foster care involvement increased with age in all groups relative to the age group 0 to 5 years old.
This study found that among youth with I/DD, Black youth and females faced higher risk for foster care involvement, and the likelihood of foster care involvement increased with age. There is an urgent need for research that focuses on addressing system-level factors that drive increased risk. Understanding the specific health needs of Black and female youth with I/DD is critical to ensure the formation, implementation, and monitoring of equitable delivery of health services.
Children who are adopted from care are more likely to experience enduring emotional and behavioral problems across development; however, adoptees’ trajectories of mental health problems and factors ...that impact their trajectories are poorly understood. Therefore, we used multilevel growth analyses to chart adoptees’ internalizing and externalizing problems across childhood, and examined the associations between preadoptive risk and postadoptive protective factors on their trajectories. This was investigated in a prospective longitudinal study of case file records (N = 374) and questionnaire-based follow-ups (N = 96) at approximately 5, 21, and 36 months postadoptive placement. Preadoptive adversity (indexed by age at placement, days in care, and number of adverse childhood experiences) was associated with higher internalizing and externalizing scores; the decrease in internalizing scores over childhood was accelerated for those exposed to lower levels of preadoptive risk. Warm adoptive parenting was associated with a marked reduction in children's internalizing and externalizing problems over time. Although potentially limited by shared methods variance and lack of variability in parental warmth scores, these findings demonstrate the deleterious impact of preadoptive risk and the positive role of exceptionally warm adoptive parenting on children's trajectories of mental health problems and have relevance for prevention and intervention strategies.
Children and adolescents in foster care experience challenging and complex health, behavioral, and developmental needs in highly mobile and complicated social environments. Frequent placement changes ...limit provider-patient relationships, disrupt continuity of care, and contribute to inaccurate health histories. These unmet needs of youth in foster care reduce their well-being, safety, and permanency. Limited integration of health care and social services results in difficulty coordinating, planning, and tracking the care of these youth, putting them at increased risk. Advanced practice nurses must consider this a population with special health care needs, utilizing a trauma-informed, integrated care approach.
Matching children with foster carers is an important step in every nonkinship family foster care placement. Although guidelines for matching are provided in several studies, the case‐specific context ...of the decision can influence the practitioners' ability to adhere to these guidelines. Therefore, this study answers the following question: “How does the case‐specific context influence the practitioners' decision‐making process regarding matching in family foster care?” Using a qualitative design, 20 semistructured interviews were conducted with practitioners matching children with foster families. Three themes emerged representing different layers of practitioners' everyday decision‐making: matching as planned, matching being tailored, and matching being compromised. The results show that exceptions are part of practitioners' daily work, either due to the belief that it might benefit those involved or because of obstacles presented during the decision‐making process. When the decision is compromised, matching practitioners lower their standards, while at the same time safeguarding the quality of the match. This proves that matching in practice is more than choosing a family, and guidelines are needed to determine what “good‐enough” matching should entail.
The disparity of problems, impairments, and disorders among children in foster care is well-documented and spans virtually every domain of functioning. Sleep, however, has received minimal attention ...among this vulnerable group, which is concerning given the multitude of ways sleep affects children's development, health, and behavior.
A total of 485 foster caregivers from across the United States completed a survey including quantitative items and qualitative, open-ended questions about sleep and related health and behavior for one child (M = 6.4 years, SD = 2.2; range 4-11 years) currently in their care.
Overall, caregivers reported developmentally appropriate child sleep and wake times; however, difficulty falling asleep (avg. 46 min per night) and staying asleep (avg. 34 min awake overnight) were common. Additionally, a high prevalence of sleep-related problems was reported including moving to someone else's bed during the night (85.8%), nightmares (51.2%), sleep terrors (26.4%), snoring (32.8%), bedwetting (31.6%), and teeth grinding (21.8%). Qualitative responses indicated emotional and behavioral challenges at bedtime, particularly elevated fear, and anxiety.
Findings are consistent with previous work finding significant health disparities among children placed in foster care. Results highlight a need for trauma-informed, behavioral sleep interventions for this pediatric population which might serve to reduce other health disparities.
•Trauma-focused cognitive behavioral therapy benefits foster care youth.•Day-to-day functioning and post-traumatic stress symptoms improve with treatment.•Older child age and home-based care may ...indicate a higher risk for termination.
Children in foster care experience trauma at a high rate, resulting in their need for effective and accessible mental health treatments. Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) has the potential to significantly improve the functional impairment and post-traumatic stress symptoms (PTSS) of children in foster care who fully complete treatment without terminating early. The purpose of this study was to explore child- and setting-level predictors (age, sex assigned at birth, race and ethnicity, treatment setting, and pre-treatment level of post-traumatic stress symptoms) of early termination and multifaceted TF-CBT effectiveness outcomes within a statewide practice initiative (N = 399). Accessibility and completion of TF-CBT within this sample of children in foster care were measured by early termination rates. Older children (7.8% more likely) and those receiving home-based TF-CBT (57.1% more likely) terminated TF-CBT early at significantly higher rates. No differences in treatment completion were found for race and ethnicity, sex assigned at birth, or pre-treatment PTSS. Results support that TF-CBT can improve PTSS and associated functional impairment at a degree that is statistically and clinically significant for children in foster care. Implications of study findings for TF-CBT treatment of foster care youth who are older and receiving home-based care are provided.
This study shows that state efforts at child protection are structured by the policy regimes in which they are enmeshed. Using administrative data on child protection, criminal justice, and social ...welfare interventions, I show that children are separated from their families and placed into foster care far more frequently in states with extensive and punitive criminal justice systems than in states with broad and generous welfare programs. However, large welfare bureaucracies interact with welfare program enrollment to create opportunities for the surveillance of families, suggesting that extensive and administratively complex welfare states engage in "soft" social control through the surveillance and regulation of family behavior. The article further shows that institutionalization, a particularly restrictive form of foster care placement, is least common in states with broad and generous welfare regimes and generally more common under punitive regimes. Taken together, these findings show that policy regimes influence the interaction between families and the state through their proximate effects on family structure and well-being and through institutional effects that delimit the routines and scripts through which policymakers and street-level bureaucrats intervene to protect children.
While a wealth of literature exists on the topic of fostering, limited research has been published on the experiences of the biological children of foster-carers (Younes and Harp, 2007; Sutton and ...Stack, 2013). Literature that exists identifies increased recognition of the importance of birth children’s contribution to successful foster-care placements and the prevention of placement breakdown (Kalland and Sinkonnen, 2001; Hojer et al., 2013). This paper reports findings from an interpretivist study that explored the retrospective experiences of fifteen adult birth children of foster-carers (aged between eighteen and twenty-eight years) in Ireland. Using semi-structured interviews, birth children’s experiences of fostering processes and their interactions with fostering professionals are explored. Findings indicate that birth children are not passive observers in how fostering influences their daily lives. Instead they use strategies to influence fostering processes, in particular to protect their parents and birth siblings, while also having feelings of responsibility for their foster siblings. Findings suggest that, despite the complexity of the fostering task, professionals should recognise and acknowledge the input of birth children to fostering. The study also suggests the value of training that encourages foster-carers to continually include the opinions of their own children in fostering decisions.
The present study provides a meta-analytic review of romantic relationships of adoptees and those who have experienced foster care. Specifically, involvement in romantic relationships and quality of ...romantic relationships were examined. The meta-analysis included studies examining adopted and biologically-reared samples (11 studies, 18 effect sizes), as well as studies examining foster and biologically-reared samples (7 studies, 11 effect sizes). Additionally, the current meta-analysis includes prevalence rates of involvement in romantic relationships for adopted (5 studies, 5 effect sizes) and foster (14 studies, 17 effect sizes) samples. Results indicate that adopted and foster samples are largely similar to biologically-reared samples in their involvement in and quality of romantic relationships. These findings represent the current state of the literature on romantic relationships of adoptees and individuals who experienced foster care. Furthermore, our findings provide important directions for future research.
•Adopted samples' romantic involvement did not differ from comparison samples.•Adopted samples show marginally higher levels of romantic relationship quality.•Foster care samples' romantic involvement did not differ from comparison samples.•Foster care and comparison samples did not differ in romantic relationship quality.
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