Parent Management Training, Relationships with Agency Staff, and Child Mental Health: Urban Foster Parents' Perspectives

Sexual abuse and disclosure concerns of youth in foster care

BACKGROUND

Youth in foster care have higher lifetime rates of sexual abuse victimization than their peers who are not in foster care. This sexual abuse occurs before, during, and after their placement. Yet there is a dearth of qualitative research focused on the characteristics of the abuse and the disclosure experiences of youth in foster care.

OBJECTIVE

We aimed to understand potential barriers to disclosure for youth who were abused while in foster care.

PARTICIPANTS & SETTING

Our study used anonymous, archival data of 143 one-on-one chat sessions on the US based National Sexual Assault Online Hotline (NSAOH) with youth currently living in foster care who sought help for sexual abuse.

METHODS

Hotline staff summarized youth's disclosure experiences and barriers using an assessment that included open-ended responses. We used thematic analysis to code text segments.

RESULTS

Youth in foster care most often discussed that the abuse was being perpetrated by a foster family member (66 %). Disclosure barriers included concerns for physical safety, not wanting to move placements, not trusting the system to keep them safe, and not wanting to disclose again after previously receiving a negative reaction to their disclosure.

CONCLUSIONS

Youth in foster care who seek help for sexual abuse while in the foster care system have unique barriers to disclosure. This study underscores the need for more qualitative research with youth in foster care and includes safety recommendations and implications for training and education of those who work with youth in foster care.

Experiences of counselors participating in an innovative project to develop a training program for specialized foster parents of youth (13-18 years)

Background

Children placed in foster care represent a vulnerable and distressed group that requires a high level of care. However, good training programs designed to address specific problems presented in specialized foster care are not easily accessible due to logistical, economic and structural barriers. The lack of easy access and a strong desire to provide high-quality services inspired counselors from a specialized foster care center on the frontline to initiate an innovative, developmentally relevant and locally grounded training program.

Aims

This study focuses on counselors' experiences with the development of the training program and its impact on their work life.

Method

A qualitative research design within a participatory approach framework was used to understand the experiences of the counselors. All the counselors employed in the department and the leaders (n = 14) participated in the study. Data were gathered from participants, including the lead and second authors, using a semi-structured interview, and analyzed using thematic analysis.

Results

The analyses yielded three main categories: (i) Psychological Factors, (ii) Social Dynamics, and (iii) Leadership Style and Support. Each of the first two categories consisted of three subcategories. At the psychological level, the employees' experiences reflected the psychological states and traits required to fuel the tasks required by the project. The social dynamics of working in a team influenced the work process and, in turn, were impacted by it. Lastly, leadership style and support provided the foundation for innovation to germinate and grow.

Conclusion

Engaging in a locally created training program was associated with a strong sense of collaboration and team spirit. Counselors reported high intrinsic motivation and a strong sense of personal pride and drive for their jobs. They were proactive in seeking colleagues with particular expertise and collaborated on project tasks despite differences. The leadership style reflected the presence of transformational leadership behaviors, signaling an organizational culture conducive to innovation. The study provides an example of how aligning employees' personal aspirations with workplace goals and professional development can create a workplace in which employees feel it is enjoyable to go to work.

Interventions targeting the mental health and wellbeing of care-experienced children and young people in higher-income countries: Evidence map and systematic review

BACKGROUND

The mental health and wellbeing of care-experienced children and young people (i.e. foster care, kinship care, residential care) is poorer than non-care-experienced populations. The Care-experienced cHildren and young people's Interventions to improve Mental health and wEll-being outcomes Systematic review (CHIMES) aimed to synthesise the international evidence base for interventions targeting subjective wellbeing, mental health and suicide amongst care-experienced young people aged ≤ 25 years.

METHODS

For the first phase of the review, we constructed an evidence map identifying key clusters and gaps in interventions and evaluations. Studies were identified through 16 electronic databases and 22 health and social care websites, in addition to expert recommendations, citation tracking and screening of relevant systematic reviews. We charted interventions and evaluations with a summary narrative, tables and infographics.

RESULTS

In total, 64 interventions with 124 associated study reports were eligible. The majority of study reports were from the USA (n = 77). Interventions primarily targeted children and young people's skills and competencies (n = 9 interventions), the parental functioning and practices of carers (n = 26), or a combination of the two (n = 15). While theoretically under-specified, interventions were largely informed by theories of Attachment, Positive Youth Development, and Social Learning Theory. Current evaluations prioritised outcomes (n = 86) and processes (n = 50), with a paucity of study reports including theoretical descriptions (n = 24) or economic evaluations (n = 1). Interventions most frequently targeted outcomes related to mental, behavioural or neurodevelopmental disorders, notably total social, emotional and behavioural problems (n = 48 interventions) and externalising problem behaviours (n = 26). There were a limited number of interventions targeting subjective wellbeing or suicide-related outcomes.

CONCLUSIONS

Future intervention development might focus on structural-level intervention theories and components, and target outcomes related to subjective wellbeing and suicide. In accordance with current methodological guidance for intervention development and evaluation, research needs to integrate theoretical, outcome, process and economic evaluation in order to strengthen the evidence base.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42020177478.

Family Minds: A randomized controlled trial of a group intervention to improve foster parents' reflective functioning

Family Minds is a brief group psychoeducational parenting intervention designed to increase the reflective functioning (RF) and mentalization skills of foster parents. RF is important for foster parents who have to build relationships with children whose adverse experiences increase their risk for psychosocial challenges. A randomized controlled trial (RCT) for Family Minds was conducted in Texas with 89 foster parents. The main aims of this study were to examine whether the intervention could significantly increase the RF/mentalization skills of the foster parents and decrease their parenting stress. After 6 weeks, compared with the control group, intervention foster parents improved their RF via a lowering of pre-mentalizing and also significantly decreased parenting stress related to parent-child dysfunctional interactions. Other measures of RF and parenting stress showed no significant differences between groups. Foster child behavior was not significantly different between groups, although data at 6 months showed a possible lowering of internalizing symptoms for children of intervention parents. This RCT provides some encouraging evidence that Family Minds may increase RF in foster parents, improve parental sensitivity and their ability to emotionally regulate, decrease parenting stress related to challenging interactions with their foster children, and possibly decrease children's internalizing behavior.

Obscure Dichotomy of Early Childhood Trauma in PTSD Versus Attachment Disorders

There are two competing schools of thoughts involving children who have experienced early childhood trauma. One posture's nosology focuses on the post-traumatic stress responses; the other focuses on the deviant behaviors that ensue from pathogenic care in early childhood. This author sought to review the literature from a holistic perspective, embracing both diagnostic positions. Seventy-three articles addressing childhood trauma and the ensuing emotional or behavioral disturbances were evaluated, mostly empirical-including 16 that specified posttraumatic stress disorder (PTSD), 21 that specified attachment disorders, and 37 that included potential overlaps between both trauma derivatives. An additional 138 studies were reviewed but not included herein because those focused on broader issues. Statistical data, financial and emotional impacts, and the effects of disrupted attachments were addressed-including both children with secure attachments and those with compromised attachments. The critical effect of both positive and negative parental responses was evaluated, as well as correlations or overlaps in the diagnostic criteria and symptom manifestations of the children and any apparent gaps in the current research. The literature details that the prognosis and course of treatment vary significantly between the two etiologies-apparently at least in part due to possible clinician bias in conceptualizations of the two populations. There are clear overlaps in the diagnostic criteria that strongly suggest comorbidity between the disorders, however, which is especially critical to analyze in the future, since there are solid, empirical, evidence-based treatment protocols for PTSD, but not for attachment disorders resulting from pathogenic caregiver maltreatment.

Relative importance of caregiver characteristics for future alcohol consumption in youth involved with child welfare system

BACKGROUND

Adolescents involved with child welfare system are disproportionately at risk for underage drinking. Little empirical evidence has informed interventions targeting child welfare caregivers to prevent alcohol consumption among adolescents involved with the system.

METHODS

The present study addressed this gap by examining modifiable caregiver characteristics most predictive of future underage drinking in a cohort of adolescents (N = 1205) in a nationally representative child welfare dataset. We used dominance analyses to examine direct contributions of each caregiver predictor to the overall variance of future alcohol use. This is the first study to apply the reputable Turrisi and Jaccard (2001) framework of familial processes affecting underage drinking to the child welfare population.

RESULTS

Findings highlight the role of caregiver-adolescent relational quality and communications for predicting underage alcohol use, and downplay the role of caregiver monitoring.

CONCLUSIONS

Child welfare service systems may help prevent underage drinking by systematically training and motivating caregivers to foster trusting, helping relationships and regular communications with the adolescents in their care.

Caregiver-Adolescent Disagreement on the Mental Health of Youth in Foster Care: The Moderating Role of the Caregiver Relationship

It is not uncommon for caregivers and adolescents to provide different perspectives of adolescents' mental health symptoms; however, few studies have examined these discrepancies, especially between foster parents and adolescents in the child welfare system. The goal of this study was to investigate the levels of disagreement on adolescent mental health symptoms among caregivers and adolescents in foster care, to examine factors associated with caregiver-adolescent discrepancies, and the potential moderating role of caregiver-child closeness on the link between the length of time the youth lived with caregivers and discrepancies regarding adolescent mental health symptoms. These research questions were examined using two measures of adolescent-caregiver disagreement, intraclass correlations and discrepancy scores, using data from a nationally representative study of youth involved with the child welfare system. Analyses of 183 adolescent-caregiver dyads revealed caregiver-adolescent disagreement on adolescents' internalizing and externalizing symptoms, with caregivers reporting higher levels of adolescents' problems on average. Adolescent gender, type of maltreatment experienced, and placement type were associated with caregiver-adolescent discrepancies. Results also indicated that closeness with caregivers significantly moderated the relationship between the length of time adolescents lived with their caregivers and discrepancies on adolescent externalizing symptoms.

The Impact of Foster Parent Training on Parenting Skills and Child Disruptive Behavior

Children in foster care are at risk for behavioral and emotional problems that require higher levels of care than other children. To meet these needs and reduce placement disruptions, foster parents require effective parenting skills. Although a number of training models have been evaluated, the findings on the efficacy of foster parent training (FPT) are mixed. We conducted a meta-analysis of the FPT outcome research from 1984 to 2014 to develop a clearer understanding of the impact of such trainings. Fifteen samples (16 studies) were identified that investigated the impact of FPT on self-reported parenting skills and knowledge and child problem behaviors. The mean effect size for child disruptive behavior using a random effects model was small but significant at -.20 (95% confidence interval [CI] = [-.39, -.01], Z = 2.05, p < .05), suggesting that, on average, foster parents who were involved in the trainings reported fewer child behavior problems than parents who did not receive the training. The mean effect size for parenting was moderate and significant at .52 (95% CI = [.22, .82], Z = 3.38, p < .05), indicating that, on average, parents in the treatment groups reported higher levels of skills and knowledge following training than did those in the control group. While these results are promising, more research is necessary to investigate the inconsistency in effect sizes across studies.