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Bogin B. What makes people grow? Love and hope. J Physiol Anthropol 2023; 42:13. [PMID: 37443075 DOI: 10.1186/s40101-023-00330-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Hope and love are popular themes of literature and art in many human societies. The human physiology of love and hope is less well understood. This review presents evidence that the lack of love and/or hope delays growth disturbs development and maturation and even kills. MAIN BODY Love and hope intersect in promoting healthy human development. Love provides a sense of security and attachment, which are necessary for healthy physical, cognitive, and emotional development. Hope provides a sense of optimism and resilience in the face of adversity. Loving relationships can foster a sense of hope in individuals and in society by providing support systems during difficult times. Similarly, having a sense of hope can make it easier to form loving relationships by providing individuals with the confidence to connect with others. Hope and love are the fundamental basis of human biocultural reproduction, which is the human style of cooperation in the production, feeding, and care of offspring. Examples are given of the association between human growth in height with love and hope, including (1) the global "Long Depression" of 1873-1896, (2) "hospitalism" and the abuse/neglect of infants and children, (3) adoption, (4) international migration, (5) colonial conquest, and (6) social, economic, and political change in Japan between 1970 and 1990. CONCLUSION Overall, this review suggests that love and hope are both critical factors in promoting healthy human development and that they intersect in complex ways to support emotional well-being.
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Affiliation(s)
- Barry Bogin
- UCSD/Salk Center for Academic Research and Training in Anthropogeny (CARTA), San Diego, USA.
- School of Sport, Exercise & Health Sciences, Loughborough University, Loughborough, UK.
- University of Michigan-Dearborn, Dearborn, USA.
- Diversity Scholars Network, Ann Arbor, USA.
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Are we using the appropriate reference samples to develop juvenile age estimation methods based on bone size? An exploration of growth differences between average children and those who become victims of homicide. Forensic Sci Int 2018; 282:1-12. [DOI: 10.1016/j.forsciint.2017.10.041] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 10/19/2017] [Accepted: 10/29/2017] [Indexed: 11/17/2022]
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Abstract
Children within institutional care settings experience significant global growth suppression, which is more profound in children with a higher baseline risk of growth impairment (e.g., low birth weight [LBW] infants and children exposed to alcohol in utero). Nutritional insufficiencies as well as suppression of the growth hormone-insulin-like growth factor axis (GH-IGF-1) caused by social deprivation likely both contribute to the etiology of psychosocial growth failure within these settings. Their relative importance and the consequent clinical presentations probably relate to the age of the child. While catch-up growth in height and weight are rapid when children are placed in a more nurturing environment, many factors, particularly early progression through puberty, compromise final height. Potential for growth recovery is greatest in younger children and within more nurturing environments where catch-up in height and weight is positively correlated with caregiver sensitivity and positive regard. Growth recovery has wider implications for child well-being than size alone, because catch-up in height is a positive predictor of cognitive recovery as well. Even with growth recovery, persistent abnormalities of the hypothalamic-pituitary-adrenal system or the exacerbation of micronutrient deficiencies associated with robust catch-up growth during critical periods of development could potentially influence or be responsible for the cognitive, behavioral, and emotional sequelae of early childhood deprivation. Findings in growth-restricted infants and those children with psychosocial growth are similar, suggesting that children experiencing growth restriction within institutional settings may also share the risk of developing the metabolic syndrome in adulthood (obesity, Type 2 diabetes mellitus, hypertension, heart disease). Psychosocial deprivation within any care-giving environment during early life must be viewed with as much concern as any severely debilitating childhood disease.
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Abstract
Children within institutional care settings experience significant global growth suppression, which is more profound in children with a higher baseline risk of growth impairment (e.g., low birth weight [LBW] infants and children exposed to alcohol in utero). Nutritional insufficiencies as well as suppression of the growth hormone-insulin-like growth factor axis (GH-IGF-1) caused by social deprivation likely both contribute to the etiology of psychosocial growth failure within these settings. Their relative importance and the consequent clinical presentations probably relate to the age of the child. While catch-up growth in height and weight are rapid when children are placed in a more nurturing environment, many factors, particularly early progression through puberty, compromise final height. Potential for growth recovery is greatest in younger children and within more nurturing environments where catch-up in height and weight is positively correlated with caregiver sensitivity and positive regard. Growth recovery has wider implications for child well-being than size alone, because catch-up in height is a positive predictor of cognitive recovery as well. Even with growth recovery, persistent abnormalities of the hypothalamic-pituitary-adrenal system or the exacerbation of micronutrient deficiencies associated with robust catch-up growth during critical periods of development could potentially influence or be responsible for the cognitive, behavioral, and emotional sequelae of early childhood deprivation. Findings in growth-restricted infants and those children with psychosocial growth are similar, suggesting that children experiencing growth restriction within institutional settings may also share the risk of developing the metabolic syndrome in adulthood (obesity, Type 2 diabetes mellitus, hypertension, heart disease). Psychosocial deprivation within any care-giving environment during early life must be viewed with as much concern as any severely debilitating childhood disease.
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Abstract
PURPOSE To determine whether young children involved with child welfare (CW) have gross motor (GM) delay; to examine relationships between GM skills and the influence of multiple factors on GM skills. METHODS One hundred seventy-six children involved with CW received GM assessment, physical examinations, and caseworker interviews. Descriptive statistics, correlations, t tests, analysis of variance and covariance, and multiple regression analyses were completed. RESULTS GM scores, lower than population norms, were associated with growth parameters. Children in kinship care had significantly higher GM scores compared with children in foster care and those with in-home protective services when adjusted for differences in time in CW. Abuse/neglect, medical neglect, and parental substance abuse produced lower scores; referral for abandonment produced higher scores. Age was most strongly related to GM outcome, with multiple regression explaining 19% of GM variance. CONCLUSION Children involved with CW have lower mean GM scores than population norms. Several factors specific to CW experiences may influence GM outcome.
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Johnson DE, Guthrie D, Smyke AT, Koga SF, Fox NA, Zeanah CH, Nelson CA. Growth and associations between auxology, caregiving environment, and cognition in socially deprived Romanian children randomized to foster vs ongoing institutional care. ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE 2010; 164:507-16. [PMID: 20368481 PMCID: PMC4126580 DOI: 10.1001/archpediatrics.2010.56] [Citation(s) in RCA: 112] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVES To determine effects of improved nurturing compared with institutional care on physical growth and to investigate the association between growth and cognitive development. DESIGN A randomized controlled trial beginning in infants (mean age, 21.0 months; range, 5-32 months), with follow-up at 30, 42, and 54 months of age. SETTING Institutionalized and community children in Bucharest, Romania. PARTICIPANTS One hundred thirty-six healthy institutionalized children from 6 orphanages and 72 typically developing, never-institutionalized children. INTERVENTION Institutionalized children were randomly assigned to receive foster care or institutional care as usual. OUTCOME MEASURES Auxology and measures of intelligence over time. RESULTS Growth in institutionalized children was compromised, particularly in infants weighing less than 2500 g at birth. Mean height and weight, though not head size, increased to near normal within 12 months in foster care. Significant independent predictors for greater catch-up in height and weight included age younger than 12 months at randomization, lower baseline z scores, and higher caregiving quality, particularly caregiver sensitivity and positive regard. Baseline developmental quotient, birth weight, and height catch-up were significant independent predictors of cognitive abilities at follow-up. Each incremental increase of 1 in standardized height scores between baseline and 42 months was associated with a mean increase of 12.6 points (SD, 4.7 points) in verbal IQ (P < .05). CONCLUSIONS Foster care had a significant effect on growth, particularly with early placement and high-quality care. Growth and IQ in low-birth-weight children are particularly vulnerable to social deprivation. Catch-up growth in height under more nurturing conditions is a useful indicator of caregiving quality and cognitive improvement.
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Affiliation(s)
- Dana E Johnson
- Department of Pediatrics, Division of Neonatology, 420 Delaware St SE, Minneapolis, MN 55455, USA.
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Jee SH, Szilagyi M, Ovenshire C, Norton A, Conn AM, Blumkin A, Szilagyi PG. Improved detection of developmental delays among young children in foster care. Pediatrics 2010; 125:282-9. [PMID: 20064864 DOI: 10.1542/peds.2009-0229] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Our goal was to determine if systematic use of a validated developmental screening instrument is feasible and improves the detection of developmental delay (DD) in a pediatric medical home for children in foster care. DESIGN AND METHODS This study had a pre-post study design, following a practice intervention to screen all children in foster care for DD by using the Ages and Stages Questionnaire (ASQ). The baseline detection rate was determined by medical chart review for all children aged 4 to 61 months who were new to foster care (NFC) during a 2-year period. After implementation of systematic screening, caregivers of young children who were NFC or already in foster care (IFC) completed the ASQ at preventive health care visits. We assessed the feasibility of systematic screening (the percentage of ASQs completed among the NFC and IFC groups). We compared the detection of DD among the baseline NFC group and the screening-NFC group by using bivariate and multivariable logistic regression. RESULTS Of 261 visits that occurred after initiation of screening, 251 (96%) visits had a completed ASQ form in the medical chart, demonstrating high feasibility. Among children who were NFC, the detection of DD was higher in the screening than baseline period for the entire population (58% vs 29%; P < .001), for each age group (infants: 37% vs 14%; toddlers: 89% vs 42%; preschool: 82% vs 44%; all P < or = .01), and for all developmental domains. On adjusted analyses, the detection of potential DD in toddler and preschool children was higher among the NFC screening group than the NFC baseline group. CONCLUSION Systematic screening for DD using the ASQ was feasible and seemed to double the detection of DDs.
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Affiliation(s)
- Sandra H Jee
- 601 Elmwood Ave, Box 777, Rochester, NY 14642, USA.
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Fisher PA, Stoolmiller M, Gunnar MR, Burraston BO. Effects of a therapeutic intervention for foster preschoolers on diurnal cortisol activity. Psychoneuroendocrinology 2007; 32:892-905. [PMID: 17656028 PMCID: PMC2174427 DOI: 10.1016/j.psyneuen.2007.06.008] [Citation(s) in RCA: 258] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2006] [Revised: 04/20/2007] [Accepted: 06/05/2007] [Indexed: 11/22/2022]
Abstract
Atypical diurnal patterns of hypothalamic-pituitary-adrenal (HPA) axis activity have been observed in samples of individuals following early life adversity. A characteristic pattern arising from disrupted caregiving is a low early-morning cortisol level that changes little from morning to evening. Less well understood is the plasticity of the HPA axis in response to subsequent supportive caregiving environments. Monthly early-morning and evening cortisol levels were assessed over 12 months in a sample of 3-6-year-old foster children enrolled in a randomized trial of a family-based therapeutic intervention (N=117; intervention condition, n=57; regular foster care condition, n=60), and a community comparison group of same-aged, non-maltreated children from low-income families (n=60). Latent growth analyses revealed stable and typical diurnal (morning-to-evening) cortisol activity among non-maltreated children. Foster children in the intervention condition exhibited cortisol activity that became comparable to the non-maltreated children over the course of the study. In contrast, children in regular foster care condition exhibited increasingly flattened morning-to-evening cortisol activity over the course of the study. In sum, improvements in caregiving following early adversity appear to have the potential to reverse or prevent disruptions in HPA axis functioning.
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Affiliation(s)
- Philip A Fisher
- Oregon Social Learning Center, 10 Shelton McMurphey Boulevard, Eugene, OR 97401, USA.
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Tarren-Sweeney M. Patterns of Aberrant Eating Among Pre-adolescent Children in Foster Care. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2006; 34:623-34. [PMID: 17019630 DOI: 10.1007/s10802-006-9045-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The paper reports epidemiological and phenomenological investigations of aberrant eating among 347 pre-adolescent children in court-ordered foster and kinship care, in New South Wales, Australia. A quarter of children displayed clinically significant aberrant eating problems, with no evidence of gender or age effects. Two distinct patterns were identified. The first is a pattern of excessive eating and food acquisition and maintenance behaviors without concurrent obesity (termed Food maintenance syndrome), resembling the behavioral correlates of Hyperphagic Short Stature (Psychosocial Dwarfism). Various data suggest this pattern is primarily triggered by acute stress, including maltreatment in care, against a background of complex psychopathology and developmental disabilities. The second is a cluster of pica-type eating behaviors that correlates with self-injurious behavior, and is closely associated with developmental disabilities. The paper includes recommendations for clinicians working with pre-adolescent children in care.
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Affiliation(s)
- Michael Tarren-Sweeney
- School of Education, University of Canterbury, Private Bag 4800, Christchurch, 8020, New Zealand.
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Dozier M, Manni M, Gordon MK, Peloso E, Gunnar MR, Stovall-McClough KC, Eldreth D, Levine S. Foster children's diurnal production of cortisol: an exploratory study. CHILD MALTREATMENT 2006; 11:189-97. [PMID: 16595852 DOI: 10.1177/1077559505285779] [Citation(s) in RCA: 148] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Young children in foster care have often experienced inadequate early care and separations from caregivers. Preclinical studies suggest that early inadequate care and separations are associated with long-term changes in regulation of the hypothalamic-pituitary-adrenal (HPA) axis. In this study, the daytime pattern of cortisol production was examined among 55 young children who had been placed into foster care and 104 children who had not. Saliva samples were taken at wake-up, in the afternoon, and bedtime for 2 days. Average salivary cortisol values for each time of day were computed. A group (foster vs. comparison) time (morning, afternoon, night) interaction emerged, reflecting less decline in levels across the day for foster than comparison children. Daytime patterns were categorized as typical, low, or high. Children who had been in foster care had higher incidences of atypical patterns of cortisol production than children who had not. These differences suggest that conditions associated with foster care interfere with children's ability to regulate neuroendocrine functioning.
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Affiliation(s)
- Mary Dozier
- Department of Psychology, University of Delaware, USA
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Abstract
Growth delay is one of the most common and persistent findings in children who have been adopted from abroad. Although the cause is not clearly understood, it may be related to the observed phenomenon of psychosocial short stature described in children from abusive and neglectful settings in western countries. Fortunately, adopted children generally experience significant improvement in growth after joining their new family, but this may put girls at risk for early and rapidly progressing puberty. This review should help the health care team to understand these issues and work better with the adoptive parents to ensure a child's smooth transition into family life.
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Affiliation(s)
- Patrick Mason
- International Adoption Center, Inova Fairfax Hospital for Children, 8505 Arlington Boulevard, Suite 100, Fairfax, VA 22031, USA.
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Rubin DM, Pati S, Luan X, Alessandrini EA. A sampling bias in identifying children in foster care using Medicaid data. ACTA ACUST UNITED AC 2005; 5:185-90. [PMID: 15913413 DOI: 10.1367/a04-120r.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Prior research identified foster care children using Medicaid eligibility codes specific to foster care, but it is unknown whether these codes capture all foster care children. OBJECTIVES To describe the sampling bias in relying on Medicaid eligibility codes to identify foster care children. METHODS Using foster care administrative files linked to Medicaid data, we describe the proportion of children whose Medicaid eligibility was correctly encoded as foster child during a 1-year follow-up period following a new episode of foster care. Sampling bias is described by comparing claims in mental health, emergency department (ED), and other ambulatory settings among correctly and incorrectly classified foster care children. RESULTS Twenty-eight percent of the 5683 sampled children were incorrectly classified in Medicaid eligibility files. In a multivariate logistic regression model, correct classification was associated with duration of foster care (>9 vs <2 months, odds ratio [OR] 7.67, 95% confidence interval [CI] 7.17-7.97), number of placements (>3 vs 1 placement, OR 4.20, 95% CI 3.14-5.64), and placement in a group home among adjudicated dependent children (OR 1.87, 95% CI 1.33-2.63). Compared with incorrectly classified children, correctly classified foster care children were 3 times more likely to use any services, 2 times more likely to visit the ED, 3 times more likely to make ambulatory visits, and 4 times more likely to use mental health care services (P < .001 for all comparisons). CONCLUSIONS Identifying children in foster care using Medicaid eligibility files is prone to sampling bias that over-represents children in foster care who use more services.
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Affiliation(s)
- David M Rubin
- Pediatric Generalist Research Group, Safe Place: The Center for Child Protection and Health of the Division of General Pediatrics, Children's Hospital of Philadelphia, Pennsylvania 19104, USA.
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Rubin DM, Alessandrini EA, Feudtner C, Localio AR, Hadley T. Placement changes and emergency department visits in the first year of foster care. Pediatrics 2004; 114:e354-60. [PMID: 15342897 DOI: 10.1542/peds.2003-0594-f] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Despite great needs, many children in foster care do not receive adequate medical care. Suboptimal care may be attributable in part to placement changes, which disrupt continuity of care by both a consistent surrogate parent and potentially a primary care physician. These disruptions in turn may lead to increased use of the emergency department (ED) for outpatient care. The primary aim of this study was to test whether a greater rate of placement changes was associated with increasing use of the ED among children in their first year of foster care. The secondary aim was to compare ED visit rates with rates of visits to other ambulatory care settings among children in foster care and other Medicaid-eligible children not in foster care. METHODS Using Medicaid claims linked to foster care administrative data, we assembled a retrospective cohort of foster children in a large urban municipality from 1993 to 1996. Eligible children spent at least 9 months in a new episode of foster care and were continuously eligible for Medicaid during a 1-year follow-up period. A comparison cohort was drawn from Medicaid-eligible children not in foster care during fiscal year 1995. The dependent variable was the rate of visits to the ED or other ambulatory care settings during a 1-year follow-up period. A negative binomial model estimated visit rates to the ED and other ambulatory care settings as the number of foster care placements increased. Potential interactions were considered between age and location of service use (ED or ambulatory care setting), between age and foster care placements, and between location of service use and number of foster care placements. RESULTS The 2358 children in the sample accounted for 1206 ED visits during the follow-up period; 38% experienced >or=2 placement changes. Children of all ages exhibited increasing reliance on the ED for ambulatory care services as the number of placements increased, with the rates of ED use more than doubling for all age groups beyond infancy. However, other ambulatory care service use increased by only 41% to 53%; there was much less utilization in these nonemergency settings for all children but particularly toddlers and infants, compared with their Medicaid-eligible peers. Although the absolute rates of all visits for younger foster children (<6 years of age) were low, older foster children had increasingly greater ED use than did their Medicaid-eligible peers, with nearly double the rate of ED visits in the adolescent age group. A temporal relationship between placements and ED visits was also identified; 75% of ED visits occurring within 3 weeks of a placement change occurred in the period after a placement change. CONCLUSIONS Foster children received fewer overall outpatient services than did their Medicaid-eligible peers, but with age and increasing numbers of placements, had higher visit rates and received a greater proportion of their overall outpatient care in the ED. These results suggest that poor access to nonemergent ambulatory care settings might have contributed to an increasing reliance on ED settings as foster care placements increased. The temporal relationship between ED visits and placement changes underscores the need for better health care management for foster children, particularly in the period after placement changes.
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Affiliation(s)
- David M Rubin
- Division of General Pediatrics, Pediatric Generalist Research Group, Safe Place: Center for Child Protection and Health, Philadelphia, PA, USA.
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Friedlaender EY, Alessandrini EA. Providing optimal emergency care for medically underserved children. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2004. [DOI: 10.1016/j.cpem.2004.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Rubin DM, Alessandrini EA, Feudtner C, Mandell DS, Localio AR, Hadley T. Placement stability and mental health costs for children in foster care. Pediatrics 2004; 113:1336-41. [PMID: 15121950 DOI: 10.1542/peds.113.5.1336] [Citation(s) in RCA: 173] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Although prior population-based studies have found that children in foster care use more mental health services than their Medicaid peers, less is known about how different experiences in foster care impact the likelihood of mental health service use. The primary aim of this study is to test the hypothesis that instability of foster care placements is associated with higher costs for mental health care services. The secondary aim is to test the hypothesis that foster care children are also more likely to generate high costs for mental health services if they generate higher costs for non-mental health claims. METHODS Using administrative child welfare data linked to Medicaid claims, we assembled a unique retrospective cohort of adjudicated dependent children >2 years old who entered foster care between July 1993 and June 1995, spent at least 9 months in care, and were Medicaid eligible during a 1-year follow-up period. The primary outcome was high mental health service use, defined as having costs in the top decile of the sample. The primary independent variables were the number of foster care placements during the year and whether placements were interrupted by a return home for at least 1 month during that year (episodic foster care). We used logistic regression to estimate the association between placements and service utilization, with adjustment for age and physical health care costs. RESULTS Of the 1635 children in the study, 41% had > or = 3 foster care placements, and 5% had episodic foster care during the year of observation. The top 10% of mental health service users accounted for 83% of the 2.4 million dollars in mental health costs. Both multiple placements and episodic foster care increased the predicted probability of high mental health service use. Higher physical health care costs also increased the probability of high mental health use for all children, but this increased probability was most dramatic among children with episodic foster care (probability of high mental health use: 0.78; 95% confidence interval: 0.42-0.94). CONCLUSIONS Foster care placement instability was associated with increased mental health costs during the first year in foster care, particularly among children with increasing general health care costs. These findings highlight the importance of interventions that address the global health of children in foster care and may permit better targeting of health care resources to subgroups of children most likely to use services.
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Affiliation(s)
- David M Rubin
- Pediatric Generalist Research Group, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA.
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Evans LD. ACADEMIC ACHIEVEMENT OF STUDENTS IN FOSTER CARE: IMPEDED OR IMPROVED? PSYCHOLOGY IN THE SCHOOLS 2004. [DOI: 10.1002/pits.10179] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Oliván Gonzalvo G. [Children and adolescents in foster care: health problems and guidelines for their health care]. An Pediatr (Barc) 2003; 58:128-35. [PMID: 12628143 DOI: 10.1016/s1695-4033(03)78016-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
In Spain, between 8,000 and 10,000 children and adolescents enter foster or residential care every year. This article aims to provide a review to increase knowledge of the health problems of minors in foster care.Sixty-five percent of the studies consulted were performed in the USA, 25 % in Spain and 10 % in other developed and industrialized countries. These studies report that a high percentage of these minors present complicated and serious physical, mental, and/or developmental problems. However, no appreciable qualitative differences in the most frequent health problems presented by these minors have been observed and there is general consensus that the high-priority health needs are the provision of preventive and/or therapeutic psychopedagogic, psychiatric, dermatologic, dental, nutritional, ophthalmologic, respiratory and immunization services. Failure to identify and provide early treatment of the health needs of these minors not only adversely affects their quality of life and future physical, emotional and intellectual development, but can also increase their difficulties in adaptation while in foster care and their future social adaptation. Their permanent relationship with the biological or adoptive family when foster care stops could also be jeopardized. Therefore, all children and adolescents in foster care should receive initial health screenings, comprehensive assessments and monitoring of their physical, mental health, and developmental status. We provide guidelines for the healthcare of these minors, which should be of use to healthcare professionals taking care of these children and adolescents while they remain in foster care.
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Affiliation(s)
- G Oliván Gonzalvo
- Servicios de Pediatría y Adolescencia. Instituto Aragonés de Servicios Sociales. Departamento de Salud, Consumo y Servicios Sociales. Gobierno de Aragón. Zaragoza. España.
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Oliván G. Catch-up growth assessment in long-term physically neglected and emotionally abused preschool age male children. CHILD ABUSE & NEGLECT 2003; 27:103-108. [PMID: 12510033 DOI: 10.1016/s0145-2134(02)00513-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE To assess the catch-up growth of long-term physically neglected and emotionally abused preschool male children who have entered foster residential care and remained 1 year after initial placement. METHOD Longitudinal study over a 7-year period (1994-2001). So that a child was eligible for the study, three selection criteria were included: (1) aged between 24 and 48 months at the time of entry into residential facility, (2) having suffered both long-term (more than 6 months) physically neglected and emotionally abused, and (3) having stayed in foster care for 1 year after initial placement. Weight, height, and head circumference were established upon entry and re-assessed 1 year after initial placement, calculating the annual growth velocity. Results were compared with normal regional longitudinal standards of reference (Z score). Student's t test was used to assess statistically significant differences. RESULTS During the study period, 87 children aged between 24 and 48 months (54 male/33 female) were admitted to residential facility after having suffered both long-term physical neglect and emotional abuse. Nevertheless, only 20 children (23% of the total admissions) met the third selection criteria (having remained 1 year after initial placement). Of these children, all were males and at placement they were between the ages of 30 and 42 months, with an average age of 36 months (1.9 SD). At placement, the analyzed parameters were below the normal standards, showing a statistically significant difference for height (Z score = -1.29; p = .008) and weight (Z score = -.75; p = .038). The annual growth velocity for all parameters was above the normal standards showing a statistically significant difference for height (Z score = +1.43; p = .009). One year after initial placement, the significant differences for height (Z score = -.68; p = .102) and weight (Z score = -.31; p = .435) with respect to the normal standards disappeared, though still remained below, showing a significant catch-up growth for height (improvement height Z = +.61 SD). CONCLUSIONS At placement, the both long-term physically neglected and emotionally abused preschool age male children showed a mild form of chronic malnutrition with growth failure. Growth failure was reversible after the first year of stay, which demonstrates that this delay in growth was secondary to nutritional and psychosocial factors. Placement in foster residential care was beneficial for the catch-up growth of these patients.
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Affiliation(s)
- Gonzalo Oliván
- Division of Pediatrics and Adolescent Medicine, Social Services Institute of Aragón, Department of Health, Consumption and Social Services, Government of Aragón, Avda de las Torres 93, 1F, 50007 Zaragoza, Spain
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Clyman RB, Harden BJ, Little C. Assessment, intervention, and research with infants in out-of-home placement. Infant Ment Health J 2002. [DOI: 10.1002/imhj.10027] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Bel J, Natal A, Cachadiña F, Mainou A, Granada ML, Rodrigo C. [Growth retardation and nutritional status in foster children]. Med Clin (Barc) 2002; 118:86-9. [PMID: 11825548 DOI: 10.1016/s0025-7753(02)72294-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Our main objective was to determine growth retardation in children entering a foster home and catch-up growth at the end of the stay. We also analyzed the nutritional status and its relationship with growth retardation. SUBJECTS AND METHOD Height and weight were determined in 118 children, aged between one month and fifteen years; they were examined at admission and at the time of leaving the center. In another group of 31 prepubertal children, we analized their nutritional status determining the body mass index, prealbumin, retinol binding protein, GHBP, IGF-1, IGFBP-3 and leptin at admission. RESULTS 31 (26.2%) out of the of the 118 children group had a height deficit (height < 2 SDS) at admission. 32 (27.1%) of the overall group of children showed significant catch-up growth after their stay at the foster home, and 15 (46.8%) of them showed a catch-up growth > 0.5 SDS. Children below two years of age showed the most important growth deficit. The nutritional status study showed normal results in all parameters in the 31 children group. Significant correlations were observed between IGF-I and weight/height, IGFBP-3 and weight/height, GHBP and body mass index, and leptin and body mass index. CONCLUSIONS An important proportion of children showed significant growth retardation at entering a foster home, although a significant catch-up growth was observed at the end of their stay. Growth failure in this population does not appear to be related to the nutritional status.
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Affiliation(s)
- Joan Bel
- Servicios de Pediatría, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.
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Evans LD. Interactional models of learning disabilities: Evidence from students entering foster care. PSYCHOLOGY IN THE SCHOOLS 2001. [DOI: 10.1002/pits.1026] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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