Intervention development to improve foster youth mental health by targeting coping self-efficacy and help-seeking

This study articulates the iterative development of an intervention called Strengthening Youth Networks and Coping (SYNC), which is designed to target coping self-efficacy and help-seeking intentions and behaviors among youth in foster care. The overarching goal is to design an intervention that will be a feasible and acceptable enhancement to existing child welfare services, and that will address modifiable determinants among adolescents involved in child welfare system that are related to elevated risk for mental health challenges, limited support network capacity, and service disengagement after exiting foster care. In this paper, we describe our initial needs assessment, explain how we selected proximal intervention mechanisms (i.e., intermediate outcomes) to target, and outline the preliminary intervention development process, including ongoing insights we received from a research advisory group including members with lived experience. Next, we report and discuss the initial acceptability pre-testing data collected from youth (N = 30) as well as feasibility data collected from providers (N = 82), results from which were used to refine the SYNC intervention framework prior to robust efficacy testing. Findings highlight the need and importance of targeting youth coping and help-seeking, integrating programming within existing transition services, delivering this content in a group-based format that includes near-peer mentors and facilitators with lived experience, and developing options that work for the heterogeneous population of young people in foster care. The results also highlight the key objective of capturing youth's interests prior to enrolling in the program (e.g., language used in recruitment materials), holding their interest throughout the program (e.g., creating opportunities for youth to engage with other youth with similar experiences), and suggestions to encourage youth's engagement and participation. This paper articulates the value of this intervention development approach, and the sequential phases of this intervention development process as well as the results, which may be useful to applied researchers and practitioners working with youth in foster care and other priority populations.

Trajectories of mental health services for youth in foster care with attention deficit hyperactivity disorder

Youth in foster care with Attention Deficit Hyperactivity Disorder (ADHD) often have significant needs for mental health services. The degree to which youth taking medication for ADHD use mental health services in relation to sibling co-placement and their level of need over time is unclear. To examine these issues, caregivers (N = 54) provided information on youth mental health service use across an 18-month study period. Results show that siblings living apart had a higher probability of mental health service use. For youth with higher CBCL scores, probability of mental health service use was both high and stable over time. However, youth with lower CBCL scores showed a decrease in probability of mental health service use over time. The sustained commitment to receipt of mental health services among youth with ADHD is something all behavioral health providers who work with foster care involved youth can benefit from, as well as the youth themselves.

Exploring mechanisms of change in a dyadic relationship intervention for siblings in foster care

There is increasing recognition of the potential for sibling relationships to promote the well-being of youth in out-of-home care. Efficacious interventions now exist to strengthen the sibling relationships for youth in out-of-home care, yet the processes through which these interventions work to enhance sibling relationships remains largely speculative. The current study therefore aimed to identify the critical components of an efficacious dyadic relationship enhancement intervention for siblings in foster care through a secondary analysis of fidelity of implementation and trial outcome data. Data for 168 youth from the treatment condition of the Supporting Siblings in Foster Care study were analysed. Fidelity of implementation was assessed across seven intervention domains: Sibs 4 Life, Positive/Sib Thinking, Activity Planning, Problem Solving, Cooperation, Managing Feelings and Adult Allies. Trial outcome data were drawn from efficacy test results and included a multi-agent construct of sibling relationship quality. Descriptive statistics detailed intervention implementation, and hierarchical linear models examined associations between intervention coverage, comprehension, and engagement, and 18-month improvements to the sibling relationship. Results indicate high fidelity to implementation, and Positive/Sib Thinking was the primary intervention domain associated with sibling relationship improvements. Considerations for future mechanisms-based intervention research with siblings in out-of-home care are provided.

Individual and interpersonal factors associated with psychosocial functioning among adolescents in foster care: A scoping review

Risk reduction and strength enhancement are both necessary strategies to improve outcomes for youth in foster care who have experienced adversity. Decades of research have articulated the negative long-term outcomes of youth in foster care, but less is known about youth-level modifiable protective factors that can be nurtured through intervention to improve well-being. This scoping review was conducted to synthesize the state of the science on proximal, modifiable individual and interpersonal factors that are associated with psychosocial well-being among adolescent youth in foster care. Following rigorous and recommended methods, we systematically searched, selected and synthesized 20 years of peer-reviewed literature focused on 13-19 year olds in foster care. 41 peer-reviewed, quantitative studies met specified inclusion criteria and were included in this review. We charted the data and synthesized our findings in consultation with an advisory group of researchers, practitioners, and youth with lived experience. Overall, the review highlighted key categories of individual factors (individual strengths, psychosocial needs, and developmental skills) and interpersonal factors (relationships with peers/siblings, caregiving adults, and caring adults in the community) that can have protective value and are associated with psychosocial functioning for adolescent youth in foster care. Moreover, when youth have their needs met, increase their skills and develop strengths, it often leads to better outcomes as well as more and/or higher quality relationships with important people in their lives. Similarly, when youth develop and maintain quality relationships, those connections often lead to opportunities to advance their skills, strengths and positive outcomes. The results of this review contribute new insights for research, practice, and policy intended to enhance psychosocial well-being for young people in foster care. Findings also highlight specific individual and interpersonal factors that interventionists might consider as potential targeted mechanisms of change when developing programming for this population. Implications are discussed.

A longitudinal analysis of school discipline events among youth in foster care

Youth in foster care experience major deficits on standardized measures of academic functioning, are at high risk of academic failure, and are more likely than their non-foster peers to be disciplined at school. School discipline-related problems increase risk of problematic educational and behavioral outcomes including dropping out of school, repeating a grade, and engagement in delinquent and criminal behavior. Identifying which youth are at greatest risk for experiencing school discipline is needed in order to improve the educational experiences of youth in foster care. The current investigation examined the effects of youth and contextual characteristics on school discipline events among 315 youth in foster care. Results revealed that being male, in a higher-grade, and a student of color, living apart from one's sibling, and school mobility significantly predicted discipline events. An additional statistical model divided youth into groups based on race, sex, and disability status taking into account the multiple identities youth have. These results suggest that gender, race, and disability status cumulatively inform school discipline experienced among youth in foster care.

Validation of a Measure of Foster Home Integration for Foster Youth

OBJECTIVES

This article introduces a youth-reported measure (Essential Youth Experiences [EYE]) developed to assess the experiences of foster youth in their home environment and their critical relationships across a number of service systems. Empirically, the article reports on the psychometric properties of a 9-item scale within the EYE that measures the construct of positive home integration (PHI).

METHODS

The EYE was administered to 328 preadolescent and adolescent youth (164 sibling dyads) enrolled in a larger randomized clinical trial.

RESULTS

Correlational analysis suggests that the PHI Scale shows good psychometric properties and strong current and predictive validity.

CONCLUSION

The PHI is a reliable and valid scale that measures youth perspectives of inclusion in the foster home and relationships with their foster care provider. This scale quickly gathers youth perspectives and differentiates between youth who have more versus less significant needs. Implications for research and social work practice are discussed.

Visualizing and Describing Foster Care Placement Pathways

This paper introduces a flowchart-based methodology for describing the movement of foster youth in and out of placements of differing types and durations. This longitudinal methodology is designed to be sufficiently simple to appeal to policymakers and administrators seeking to chart the movement of groups of youth over time and the sequencing of their placements, and sufficiently descriptive to be of use to researchers seeking to predict the placement trajectories of subgroups of foster youth. The paper provides an example of the use of the method drawing upon state administrative data from a large study of preadolescent and adolescent youth in foster care situated in Oregon. Implications for the application of the methodology to different issues of interest to researchers, policymakers, and administrators are discussed.

Foster home integration as a temporal indicator of relational well-being

This study sought to identify factors that contribute to the relational well-being of youth in substitute care. Using data from the [BLIND] study, youth responded to a 9-item measure of positive home integration, a scale designed to assess the relational experiences of youth to their caregivers and their integration into the foster home. Data were collected from youth in six month intervals, for an 18-month period of time. Latent growth curve modeling procedures were employed to determine if child, family, and case characteristics influenced youth's home integration trajectories. Results suggest stability in youth reports of home integration over time; however, children who were older at the time of study enrollment and youth who experienced placement changes during the period of observation experienced decreased home integration during the 18-month period. Results suggest youth's perspectives of home integration may in part be a function of the child's developmental stage and their experiences with foster care placement instability. Implications for practice and future research are discussed.

Network Indicators of the Social Ecology of Adolescents in Relative and Non-Relative Foster Households

Though the presence, composition, and quality of social relationships-particularly as found in family networks-has an important influence on adolescent well-being, little is known about the social ecology of youth in foster care. This study examined the social networks of foster youth participating in a large RCT of an intervention for siblings in foster care. Youth reported on the people they lived with and the relatives they were in contact with, which provided indicators of network size, composition, and relationship quality. Cluster analysis was used to identify five family network profiles for youth living in foster homes. Two identified subgroups reflected robust family networks where youth were living with relative caregiver(s) and related youth, and also reported multiple family ties outside the household, including with biological parents. The remaining three profiles reflected youth reports of fewer family connections within or beyond the foster household, with distinctions by whether they lived with siblings and/or reported having positive relationships with their mothers and/or fathers. The identified network profiles were validated using youth- and caregiver-reported measures of mental health functioning, with increased caregiver report of post-traumatic stress symptoms indicated for the three subgroups that were not characterized by a robust family network.

An intervention to improve sibling relationship quality among youth in foster care: Results of a randomized clinical trial

Sibling programming is an important part of a prevention framework, particularly for youth in foster care. After children are removed from their families and placed into foster care in the aftermath of maltreatment, the sibling relationship is often the most viable ongoing relationship available to the child, and may be critical to a youth's sense of connection, emotional support, and continuity. The promise of dyadic sibling programming in particular rests on the ability of interventions to enhance the quality of sibling relationships; yet little research exists that suggests that sibling interventions can improve relationship quality among foster youth. The primary aim of the current study was to examine the effects of a specific dyadic sibling-focused intervention for older and younger siblings on sibling relationship quality. One hundred sixty four dyads (328 youth) participated in the study, with each dyad consisting of an older sibling between 11 and 15 years of age at baseline and a younger sibling separated in age by less than 4 years. Hierarchical linear models were applied to self-reported, observer-reported and observational data over the 18-month study period. Findings suggest that the sibling intervention holds promise for improving sibling relationship quality among youth in foster care. Implications and future directions for research are discussed.

Foster care placement change: The role of family dynamics and household composition

Sibling co-placement and kinship care have each been shown to protect against the occurrence of placement change for youth in substitute care. However, little is known about the effects of different combinations of sibling placement and relative caregiver status on placement change. Nor does the field fully understand how family dynamics may differ in these households. Utilizing data from the Supporting Siblings in Foster Care study, this paper examines family dynamics across four typologies of living composition, and tests the effects of living composition membership on the odds of experiencing a placement change over an 18-month period of time. Findings suggest that across living composition typologies, children who were placed separately from their siblings in non-relative care were more likely to be older, have more extensive placement histories, and experience more placement changes both prior to and during the study than were children in other living composition groups. Family living composition was found to influence the occurrence of placement change. Specifically, children co-placed in kinship care were least likely to experience movement; however, sibling co-placement in non-relative care was also protective. Results reveal the need to conduct additional research into the experiences of children in different family living arrangements, and tailor case management services and supports to children in substitute care accordingly. Implications and future directions are discussed.

Development and feasibility of a sibling intervention for youth in foster care

Due to their ubiquity and possible influence on youth mental health, academic, and other outcomes, sibling-focused intervention strategies may be important for the development and implementation of evidence-based practices (EBPs) in child welfare. However, there is no rigorous evidence as to either the best methods for, or feasibility of, incorporating the sibling link within existing clinical treatments for foster youth. This paper applies the literature on evidence-based practices (EBP) and implementation research in child welfare to sibling-focused intervention; and presents data concerning the development, delivery, cost, and feasibility of a novel sibling-focused intervention program, Supporting Siblings in Foster Care (SIBS-FC). Results suggest that despite the challenges and costs involved with delivering SIBS-FC, the program catered to the diverse needs of pre-adolescent and adolescent siblings living together and apart, was viewed positively by youth, and was implemented with a high degree of fidelity. These findings underscore the importance of attending to the early-stage development of psychosocial interventions in child welfare and highlight the role of interagency collaboration, program planning, staff training and supervision, and fidelity tracking for EBP development in child welfare. Implications for prevention research and sibling-focused intervention programming in child welfare are discussed.

Alcohol and Substance Use in Adolescence and Young Adulthood: The Role of Siblings

Interpersonal relationships both within and outside the family have been a central part of alcohol and substance use research. Many studies have focused on the role of parents and peers; fewer studies have focused on siblings. This paper examined siblings' roles in ATOD use patterns and trajectories in the context of familial and non-familial factors across time. First, intraclass correlations (ICCs) were used to examine the degree to which older siblings' ATOD use was associated with younger siblings' ATOD use. Second, hierarchical regression analyses were conducted to examine the degree to which individual, parent, sibling and peer factors over time were associated with adolescents' and young adults' ATOD use. It should be noted that developmentally proximal predictors were utilized in these models and within-family replication was also examined. Results demonstrate strong associations between older and younger siblings' ATOD use. Moreover, the developmentally proximal sibling variables were predictive of younger sibling ATOD use in the context of other variables across all substances. Study findings are discussed in terms of identifying promising and potentially malleable points of intervention for future investigators.

Intervening to Improve Outcomes for Siblings in Foster Care: Conceptual, Substantive, and Methodological Dimensions of a Prevention Science Framework

In recent years, the child welfare field has devoted significant attention to siblings in foster care. Policymakers and practitioners have supported efforts to connect siblings via shared foster placements and visitation while researchers have focused on illuminating the empirical foundations of sibling placement and sibling intervention in child welfare. The current paper synthesizes literature on sibling relationship development and sibling issues in child welfare in the service of presenting a typology of sibling-focused interventions for use with foster youth. The paper provides two examples of current intervention research studies focused on enhancing sibling developmental processes and understanding their connection to child welfare outcomes. The paper concludes by presenting an emerging agenda informing policy, practice, and research on siblings in foster care.