Early Child Adversity and Delinquent Behavior in Foster Care Youth: Do Future Expectations and Sexual Identity Moderate the Mediating Role of Posttraumatic Stress?

Purpose

Delinquency in youth is a significant public health concern for individuals who experienced adversity and complex trauma as children. The present study explored the longitudinal associations between adverse child experiences and future engagement in delinquent behavior.

Methods

Using a sample of 1,245 foster youth who are aging out of the child welfare system, mediation, moderation, and moderated mediation analysis was used to test the mechanistic role of post-traumatic stress symptoms and the moderating role of sexual identity and positive future expectations on engagement in delinquent behavior.

Results

Results showed a positive and significant association between adverse child experiences and engagement in delinquent behavior. Post-traumatic stress symptoms partially mediated the ACEs-delinquency relationship. In addition, sexual minority youth and youth who were less optimistic about the future, but who experienced more ACEs, were at risk for heightened levels of post-traumatic stress.

Conclusions

Interventions that promote positive future outlooks may minimize the psychological sequelae of early child adversity and delinquent behavior particularly when tailored to the needs of sexual minority youth.

Experiences of the COVID-19 pandemic among young parents with foster care backgrounds: A participatory action PhotoVoice study

The COVID-19 pandemic has had a disproportionate impact on many vulnerable populations, including youth in foster care and parents of young children. In this study, we worked with nine parenting current and former foster youth to share their experiences of the COVID-19 pandemic through photography. Data were collected between January and March 2021 during a series of three virtual PhotoVoice sessions, then transcripts of PhotoVoice sessions and participant-selected captioned photographs were analyzed using thematic analysis. Themes in participants' photographs included 1) Pandemic Parenting and 2) Making the Best of It. Findings indicate the need to expand mental health services, protect essential workers, and ensure young parents receive support navigating medical and social welfare systems and the process of receiving pandemic relief-related benefits.

How do Students Involved with a Campus Support Program for Students with a History of Foster Care, Relative Care, or Homelessness Fare After Graduation?

Background

Postsecondary education can provide opportunities for students from traditionally hidden populations like those who have experienced foster care or homelessness. To assist these students, campus support programs (CSPs) provide a wide range of services and activities.

Objective

Evidence of the impact of CSPs is limited, and little is known about how students who were involved in CSPs fare at or after graduation. This study seeks to address these gaps in knowledge. Methods: This mixed-methods study surveyed 56 young people involved in a CSP for college students who have experienced foster care, relative care, or homelessness. Participants completed surveys at graduation, 6 months post-graduation, and one-year post-graduation.

Results

At graduation, over two-thirds of the students felt completely (20.4%) or fairly (46.3%) prepared for life after graduation. Most felt completely (37.0%) or fairly confident (25.9%) that they would get a job after graduation. Six months after graduation, 85.0% of the graduates were employed, with 82.2% working at least full-time. 45% of the graduates were enrolled in graduate school. These numbers were similar a year after graduation. Post-graduation, participants described areas of their lives that were going well, obstacles and hardships faced, changes they would like to see in their lives, and post-graduation needs. Across these areas themes were present in the areas of finances, work, relationships, and resilience.

Conclusions

Institutions of higher education and CSP should assist students with a history of foster care, relative care, and homelessness to ensure that after graduation, they have adequate money, employment, and support.

Potential traumatic events and symptoms of post-traumatic stress in unaccompanied refugee minors-a comparison with youth in foster care

Building knowledge on how child welfare services (CWS) should tailor services for unaccompanied refugee minors (URMs) is important. URMs and youth in foster care are high-risk groups taken care of by the CWS in Norway. Little is known on whether knowledge gained from youth in foster care can inform services for URMs, and if these groups are comparable in terms of experiences of potential traumatic events (PTEs) and post-traumatic stress disorder (PTSD) symptom load. Eighty-one URMs reported PTEs and PTSD-symptoms using an adapted version of the Child and Adolescent Trauma Screen (CATS). Responses were described and compared with a sample of 303 youth in foster care in linear regression models. We present relative risks (RR) and standardized mean differences (SMD) for the PTEs and the PTSD subscale and total score between the groups in forest plots. URMs had experienced a mean (standard deviation) of 6.4 (3.4) PTEs and 43.9% reported to have PTSD-symptoms at or above the clinical cut off. Compared to the foster youth, URMs reported more exposures of interpersonal violence outside of the family (RRs ranging from 66.4 [95%CI 18.1; 243.5) to 1.3 (1.0, 1.5)], and more PTSD-symptoms in the re-experiencing subscale [SMD = 0.3 (95% CI 0.1, 0.6)]. The frequency and types of PTEs and the PTSD-symptom load and profile among URMs and youth in foster care differed. Findings underscore the importance of qualified and targeted care for URMs, and that this care should differ to that of other high-risk groups in the CWS.

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.

Technology-Based Smoking Cessation for Youth Exiting Foster Care: A Pilot Randomized Trial

Despite high rates of cigarette use, little attention has been paid to screening and cessation services for youth in foster care. Study aims were to test the feasibility, acceptability, and preliminary efficacy of a technology-based smoking cessation intervention. Study enrollment, satisfaction, and engagement were high in the intervention arm, where readiness to change also significantly increased over time. Intervention and control participants significantly reduced cigarette use at 6-month follow up, though groups did not differ. Technology-based interventions appear to be attractive and offer a potentially scalable link to health care that this vulnerable population may not otherwise seek.

Mitigating Risks of Incarceration Among Transition-Age Foster Youth: Considering Domains of Social Bonds

Transitioning to adulthood is difficult for young people aging out of foster care. Research shows that this population faces substantial challenges in trying to avoid legal system involvement during this difficult period of life. Seeking to improve our understanding of the protective factors that mitigate the risks of legal system involvement among transition-age foster youth, this study focuses on social bonds as predictors. Drawing from social control theory and using longitudinal foster youth survey data (n = 687), we explore two domains of social bonds (interpersonal bonds, institutional bonds) youth had at the onset of adulthood (age 17), and assess the association between domains of social bonds and later incarceration in early adulthood (between ages 17 and 21). While results provide no support for the significance of interpersonal bondedness, institutional bonds were significantly associated with decreased odds of later incarceration. This suggests that social bonds may be stronger for institutional domains than for interpersonal domains in helping youth to avoid later incarceration. These findings help explain why some youth navigate the transition to adulthood better than others with regard to legal system involvement, and inform efforts to develop policy and provide services more effectively. Implications and recommendations for the field and professionals are discussed.

Foster youth's placement preferences: The roles of kin, siblings, and age

BACKGROUND

Debates exist regarding whether foster youth should be asked about their placement preferences following removal, with only youth aged 12 years and older at times assumed legally competent to provide input.

OBJECTIVES

The present study evaluated whether placement-related factors known to predict youth's well-being also shape their placement preferences and whether preferences differ between youth below and above the age at which they are considered legally competent to provide input.

METHOD

Data (N = 1033, ages 6-17 years, 54 % female) were obtained from NSCAW-I. Youth were asked open- and closed-ended questions about their placement preferences.

RESULTS

Among youth removed for shorter periods, placement with kin was related to a greater preference for their current placement (RRR = 0.31, p < .001) and desire for permanency in that placement (OR = 1.95, p = .005) relative to youth placed with non-kin. However, youth removed for longer periods (e.g., a year) were similar in their desires for their current placement to be permanent regardless of whether they were living with kin or non-kin caregivers. Among younger youth, placement with siblings (RRR = 0.42, p = .015) was linked to a preference for their current placement. Racial match between youth and their non-kin caregiver was unrelated to their placement preferences.

CONCLUSIONS

Findings revealed that both younger and older youth's placement preferences were shaped by factors objectively linked to youth's well-being and thus align with best practices in placement decisions. The paper discusses the importance of asking youth as young as 6 years about their placement preferences and offers suggestions for social service and legal professionals regarding questioning strategies.

Patterns of healthcare utilization with placement changes for youth in foster care

BACKGROUND

Children in foster care experience poor health and high healthcare use. Child welfare agencies frequently require healthcare visits when children enter foster care; subsequent placement changes also disrupt healthcare. Studies of healthcare use have not accounted for placement changes.

OBJECTIVE

To understand patterns of healthcare use throughout the time a child enters foster care and with placement changes, accounting for mandated visits when children enter foster care or experience a placement change.

PARTICIPANTS AND SETTING

Children 4 and older in foster care between 2012 and 2017 (N = 2787) with linked child welfare administrative data from one county child welfare agency and one Midwest pediatric healthcare system.

METHODS

Negative binomial models predicted healthcare days per month that were planned (e.g., scheduled primary/specialty care), unplanned (e.g., emergency care), or missed.

RESULTS

Planned healthcare days increased as a function of placement changes (Incident Rate Ratio [IRR] =1.69, p < .05) and decreased with placement stability (IRR = 0.92, p < .01). Mandated visits that occurred later in a placement were associated with fewer planned (IRR = 0.81, p < .01) and unplanned (IRR = 0.82, p < .01) healthcare days during that placement.

CONCLUSIONS

Patterns of planned healthcare over the time children are in one placement and move between placements suggest more can be done to ensure youth remain connected to primary and specialty care throughout placements and placement transitions, s that children are seen as clinically appropriate rather than a function of placement disruption. Findings regarding the timing of mandated visits suggest that delays in mandated care may also reflect lower healthcare use overall.

COVID-19 Vaccination Perspectives Among Young Parents with Foster Care Backgrounds

The COVID-19 pandemic has brought unique stressors for youth in foster care and recent foster care alumni, particularly those who are also parenting young children. One way the pandemic can be mitigated is through vaccination of the general population. Yet, some young adults have been slow to choose to be vaccinated. As has been demonstrated, simple availability of the COVID-19 vaccine will not guarantee its uptake, especially among marginalized populations. In order to better understand the nuances of vaccination among youth in foster care and recent foster care alumni, we conducted in-depth, semi-structured focus groups and interviews with 23 parenting youth with foster care histories aged 18-26 years. Data regarding vaccine attitudes were analyzed using thematic analysis. Participating youth, who were majority Black, Indigenous, and people of color (BIPOC) and often lived in multigenerational households, had significant concerns about the COVID-19 vaccine. They expressed varying degrees of intention to get vaccinated. Young people, especially those who belong to marginalized populations, need opportunities to openly discuss their vaccination-related questions without judgment. Science communicators should consider these questions and address youths' concerns through diverse voices and channels to ensure youth have the information they need to make an informed decision regarding COVID-19 vaccination.

Experiences of young adults with a history of foster care during COVID-19

This study assessed the needs, concerns, and strengths of young adults (ages 18-26), previously placed in foster care, in response to coronavirus disease 2019 (COVID-19). One hundred and twenty-seven participants completed the survey in May and June, offering a preliminary description of the impact of Shelter in Place (SIP) due to COVID-19 on their well-being. The mixed-methods, cross-sectional survey assessed participants' perspectives regarding (1) changes in physical, financial, professional, social, relational, and psychological levels of concern and (2) the general impact of SIP due to COVID-19, as well as the unique impact as a current or former foster youth. Participants reported significant increases in their level of concern in each domain from before SIP orders to during SIP, which was maintained in anticipation of the year following SIP. Participants also described their experiences with SIP and COVID-19 as unique, due to their lived experience as a former foster youth. Findings highlight a need for a coordinated short and long-term response to address the needs and concerns of this vulnerable population.

The Impact of Maltreatment on Internalizing Symptoms for Foster Youth: an Examination of Spirituality and Appraisals as Moderators

Research shows that exposure to child maltreatment increases the risk of internalizing symptoms for youth, and that youth in foster care are at a particularly high risk of symptoms. However, not all youth who experience maltreatment evidence maladjustment, making the link between exposure and mental health outcomes unclear and creating a need to examine what factors buffer against symptomatology. A sample of youth in foster care was used to provide a new examination of the relation between child maltreatment exposure and internalizing symptoms, to test the possible moderating effects of both appraisals and spirituality, and examine differences between children and adolescents. Participants were 486 youth in foster care (M age = 13; 204 children; 282 adolescents). Youth completed self-report measures through the SPARK project (Studying Pathways to Adjustment and Resilience in Kids). Although appraisals and spirituality were not significant moderators, significant main effects emerged. For children, regression analyses showed that maltreatment exposure and lower scores on spiritual prosocial attitudes accounted for the majority of the 21% of the variance in internalizing symptoms. For adolescents 28% of the variance in internalizing symptoms was accounted for by greater maltreatment exposure, lower scores on spiritual prosocial attitudes, higher scores on relationship with a God/Higher Power, and more negative appraisals of stressful life events. The current study provides support for cognitive-based interventions for adolescents aimed at increasing appraisal flexibility and suggests that both children and adolescents could benefit from the development of prosocial attitudes often tied to spirituality but could be reinforced in additional settings.

Predictors of remaining in foster care after age 18 years old

BACKGROUND

The Fostering Connections to Success and Increasing Adoptions Act of 2008 created the option for U.S. states to extend the foster care age limit up to the 21 st birthday. The law provides foster youth extra protections while they transition to adulthood.

OBJECTIVE

To inform states' efforts to better design and implement extended foster care (EFC), we examine the impact of the policy change on length of EFC stay and factors associated with youth's time in EFC.

PARTICIPANTS AND SETTING

We use two samples of foster youth in California that extended the foster care age limit to 21 in 2012: 37,827 youths who turned 18 between the years 2008 and 2014 and 711 youths who participated in an interview-based panel study.

METHODS

Leveraging California's child welfare administrative data and California Youth Transitions to Adulthood Study's (CalYOUTH) survey data, we investigated predictors of months youths remained in EFC with linear regression and Cox proportional hazard regression.

RESULTS

Almost half of youth eligible for EFC remained in care until their 21 st birthday. These cohorts stayed in foster care up to 16 months longer (p < .001) than previous cohorts without an EFC option. Multiple individual factors were associated with youths' length of stay in EFC. However, a youth's county of placement made a greater difference on their time in EFC-up to 16 months (p < .05).

CONCLUSIONS

Our findings underscore the importance that placement location has on how long youth remain in EFC, and expands our understanding of how county and state context shape EFC participation.

Measuring self-reported polyvictimization in foster youth research: A systematic review

BACKGROUND

Youth who are or have been in foster care (foster youth) are at higher risk for adverse outcomes in early adulthood. As the importance and complexity of victimization experiences, including types, timing, and perpetrators, is better understood it is unclear whether or to what extent the research on foster youth assesses polyvictimization. Because many types of victimization, such as community violence, are under-reported or absent in the administrative data typically used for research with foster care populations, self-reports of victimization experiences are necessary to comprehensively assess polyvictimization. Polyvictimization places youth at increased risk for adverse outcomes, and yet is not widely measured in the foster youth population. This is likely in part due to the wide-use of administrative reports to assess maltreatment among research on foster youth which does not capture a full range of victimization experiences.

OBJECTIVE

The aim of the present study was to systematically review and evaluate the measurement of self-reported polyvictimization with foster youth samples.

METHODS

A search in Academic Search Premier, MEDLINE, PsycARTICLES, Psychology and Behavioral Sciences Collection, Social Work Abstracts, SociINDEX, and Scopus was conducted. Articles included peer-reviewed, quantitative research studies that measured self-reported victimization (including violence exposure and/or maltreatment) with foster youth samples between 1997-2017. In total, 1887 studies were identified and reviewed by two raters and of those 18 met the study criteria.

RESULTS

Almost all of the included studies (n = 16) measured multiple types of victimization through self-report. The most common types of victimization measured were sexual abuse (n = 15), physical abuse (n = 14), and physical neglect (n = 11). Half of studies (n = 9) measured at least one non-maltreatment victimization experience, such as community violence exposure and/or dating violence. However, included studies rarely measured other aspects of victimization, such as timing of exposure (e.g., pre or during foster care), which research has identified as relevant to outcomes.

CONCLUSIONS

This is the first systematic review to assess the measurement of self-reported polyvictimization in research with current or former foster youth. Given the limited comprehensive assessment of victimization, these findings support strong recommendations for developing or adapting polyvictimization measures specifically for foster youth so that the measures include child welfare-specific factors such as the timing and perpetration of victimization experiences.

The Impact of Sociosexualization and Sexual Identity Development on the Sexual Well-Being of Youth Formerly in the Foster Care System

PURPOSE

Youth in the child welfare system experience disproportionate rates of negative sexual health outcomes as well as increased engagement in risky sexual behaviors. This study explored the impact of sociosexualization and sexual identity development on the sexual well-being of youth formerly in the foster care system.

METHODS

Two hundred and nineteen youth formerly in the foster care system completed an Internet-based survey, including measures of the level of sexuality-related topics discussion, relationship quality with the individual with whom the topics were discussed, adverse childhood experiences, severity of sexual abuse history, sexual identity development, and sexual well-being. Hierarchical regressions examined the impact of youths' sociosexualization experiences and four domains of sexual identity development on their sexual well-being.

RESULTS

Sexual Identity Commitment was the strongest positive predictor of youths' sexual well-being (β = .428) followed by Sexual Identity Synthesis/Integration (β = .350) and Sexual Identity Exploration (β = .169). Sexual Orientation Identity Uncertainty negatively impacted sexual well-being (β = -.235), as did adverse childhood experiences (β range = -.150 to -.178) and sexual abuse severity (β range = -.208 to -.322). Sexuality-related discussions with foster parents negatively impacted youths' sexual well-being, whereas discussions with peers were a positive predictor.

CONCLUSION

Enhancing youths' sexual identity development and reducing the impact of traumatic experience are critical to improving sexual well-being. The influence of sexuality-related discussions on sexual well-being requires further analysis as impacts varied widely. Public policies should provide guidance to professionals on what services should be provided to enhance youths' sexual development.

Potentially traumatic events in foster youth, and association with DSM-5 trauma- and stressor related symptoms

BACKGROUND

In DSM 5, three disorders are related to trauma and/or maltreatment: Post-traumatic Stress Disorder (PTSD), Reactive Attachment Disorder (RAD) and Disinhibited Social Engagement Disorder (DSED) but how these disorders relate to each other and to traumatic events is unknown.

OBJECTIVE

We examined 1. Prevalence of Potentially Traumatic Events (PTEs) and poly-victimization for youths in foster care. 2. Associations between single/multiple PTEs and PTSD, DSED, and the two symptom-clusters that constitute RAD: Failure to seek/accept comfort (RAD A), and Low social-emotional responsiveness/ emotion dysregulation (RAD B).

PARTICIPANTS, SETTING AND METHODS

Foster youth 11-17 years (N = 303) in Norway completed The Child and Adolescent Trauma Screen. Foster parents completed the RAD and DSED Assessment interview.

RESULTS

Foster youth reported experiencing, on average, 3.44 PTEs each (range 0-15, SD 3.33), and 52.9 % reported PTSD symptoms at or above clinical cut off. The PTE sum score was associated with the latent factors PTSD (r = .66, p < 0.001), RAD cluster B symptoms (Low social-emotional responsiveness / emotion dysregulation, r = .28, p < 0.001) and DSED (r = .11, p = 0.046), but not with RAD cluster A symptoms (Failure to seek/accept comfort).

CONCLUSIONS

These findings raise new questions about the nature, mechanisms and timing of development of RAD and DSED. Maltreatment assessment needs to encompass a wide range of PTEs, and consider poly-victimization.

Prospective associations between trauma, placement disruption, and ethnic-racial identity among newly emancipated foster youth

INTRODUCTION

Ethnic-racial identity (ERI) is an important developmental process for ethnic-racial minority youth. However, little is known about how adverse life experiences may be related to ERI development. Thus, the current study evaluated prospective associations of emancipated foster youth's histories of childhood maltreatment and foster placement disruption with ERI centrality and ERI private regard, as well as the adaptive implications of ERI.

METHOD

Participants were 144 emancipated foster youth (69.4% female) from ethnic-racial minority backgrounds (27.8% Black, 32.6% Latinx, 39.6% multiracial) who participated in a longitudinal study of youth's adaptation to aging out of the US child welfare system. Youth reported on their childhood maltreatment severity and child welfare placement history at wave 1 (M_{age_w1} = 19.62, SD = 1.11), and on their ERI centrality, ERI private regard, and socioemotional adjustment (i.e., social support, self-esteem, anxiety and depressive symptoms, and life satisfaction) five years later (M_{age_w2} = 24.15).

RESULTS

Path analyses revealed that childhood maltreatment severity and placement disruption were associated with lower ERI private regard, but not ERI centrality. Moreover, private regard was associated with better socioemotional adjustment (i.e., higher levels of self-esteem and social support), whereas centrality was related to poorer adjustment (i.e., lower levels of self-esteem and life satisfaction, and higher rates of anxiety and depressive symptoms), and these relations varied by ethnicity-race.

CONCLUSIONS

The current findings suggest that efforts to promote positive feelings toward one's ethnic-racial group membership can support ethnic-racial minority foster youth's capacity to negotiate developmental challenges in and beyond the child welfare system.

Exploring the Relationship Between Foster Care Experiences and HIV Risk Behaviors Among a Sample of Homeless Former Foster Youth

Recent research shows high rates of poor behavioral health outcomes among homeless former foster youth, including increased risk for HIV-risk behaviors. In the current study, data were collected from 184 youth at drop-in centers in Los Angeles using behavioral health questionnaires to explore the relationships between specific aspects of foster care experiences and engagement in HIV-risk behaviors. Results indicated that youth whose first homelessness experience occurred before leaving foster care were significantly more likely to engage in drug use with sex and exchange sex than those whose first homelessness experience occurred after leaving foster care. Intervention services targeting HIV-risk behaviors should consider the aspects of foster care placements that may increase the risk of these behaviors, such as long periods of placement or experiencing homelessness before exiting foster care, as well as those that may decrease the risk of these behaviors, such as exiting placement at an older age.

Services according to mental health needs for youth in foster care? - A multi-informant study

BACKGROUND

Foster children have a high risk of mental disorders. This has contributed to increased international attention to service utilization for youth in foster care. The aim of this study is to examine whether youth in foster care receive services according to need, by using a multi-informant design.

METHOD

Detailed information on the type and frequency of service use during the last 2 years and on youth mental health were collected from foster youths and their carers in Norway (n = 405, aged 11-17 years) through online questionnaires. Mental health was assessed with the Strengths and Difficulties Questionnaire. Statistical analyses were conducted using descriptive statistics and log-binominal regressions.

RESULTS

In total, 48.8% of foster youths showed evidence of mental health problems, and 74.5% of foster families had contact with services. Increased mental health problems and living in non-kin foster care were associated with more service use. Youths with mental health problems had twice the probability of receiving services from the child and adolescent mental health service (CAMHS) and primary health care services compared to youths without problems. However, 57.0% of youths with carer-reported mental health problems did not have contact with CAMHS.

CONCLUSIONS

Service use among foster youths was associated with service need rather than demographic and placement characteristics. The majority of youths with mental health problems did not receive services from CAMHS. However, many of them were in contact with primary health care services.

The predictors of perceived social support among former foster youth

Based on a 5-wave panel survey of 732 foster youth, the current study examined the respective relationships between foster youths' individual characteristics, youths' social connections with individuals and formal institutions, and the development of perceived social support across the transition to adulthood. Several youth characteristics - including self-reported delinquency and attachment insecurity - were found to be statistically significantly associated with perceived social support. Attachment insecurity also appeared to mediate the relationships between social support and several other youth-level characteristics, including prior placement disruptions and placement with relatives. Social connections with different types of individuals - including caregivers, relatives, natural mentors, and romantic partners - were found to be associated with additive increases in perceived social support. However, some types of connections (e.g., romantic partners, natural mentors) appeared to be associated with much larger increases in social support than other connections (e.g., school or employment). Collectively, the findings help inform agencies' efforts to bolster foster youths' social connections as they transition to adulthood.

The blind men and the elephant: Identification of a latent maltreatment construct for youth in foster care

Child maltreatment is a major public health concern due to its impact on developmental trajectories and consequences across mental and physical health outcomes. Operationalization of child maltreatment has been complicated, as research has used simple dichotomous counts to identification of latent class profiles. This study examines a latent measurement model assessed within foster youth inclusive of indicators of maltreatment chronicity and severity across four maltreatment types: physical, sexual, and psychological abuse, and neglect. Participants were 500 foster youth with a mean age of 12.99 years (SD=2.95years). Youth completed survey questions through a confidential audio computer-assisted self-interview program. A two-factor model with latent constructs of chronicity and severity of maltreatment revealed excellent fit across fit indices; however, the latent constructs were correlated 0.972. A one-factor model also demonstrated excellent model fit to the data (χ² (16, n=500)=28.087, p=0.031, RMSEA (0.012-0.062)=0.039, TLI=0.990, CFI=0.994, SRMR=0.025) with a nonsignificant chi-square difference test comparing the one- and two-factor models. Invariance tests across age, gender, and placement type also were conducted with recommendations provided. Results suggest a single-factor latent model of maltreatment severity and chronicity can be attained. Thus, the maltreatment experiences reported by foster youth, though varied and complex, were captured in a model that may prove useful in later predictions of outcome behaviors. Appropriate identification of both the chronicity and severity of maltreatment inclusive of the range of maltreatment types remains a high priority for future research.

Positive change following adversity and psychological adjustment over time in abused foster youth

Many foster youth experience maltreatment in their family-of-origin and additional maltreatment while in foster care. Not surprisingly, rates of depression are higher in foster youth than the general population, and peak during ages 17-19 during the stressful transition into adulthood. However, no known studies have reported on whether foster youth perceive positive changes following such adversity, and whether positive change facilitates psychological adjustment over time. The current study examined components of positive change (i.e., compassion for others and self-efficacy) with depression severity from age 17 to 18 as youth prepared to exit foster care. Participants were youth from the Mental Health Service Use of Youth Leaving Foster Care study who endorsed child maltreatment. Components of positive change and severity of abuse were measured initially. Depression was measured initially and every three months over the following year. Latent growth curve modeling was used to examine the course of depression as a function of initial levels of positive change and severity of abuse. Results revealed that decreases in depression followed an inverse quadratic function in which the steepest declines occurred in the first three months and leveled off after that. Severity of abuse was positively correlated with higher initial levels of depression and negatively correlated with decreases in depression. Greater self-efficacy was negatively associated with initial levels of depression and predicted decreases in depression over the year, whereas compassion for others was neither associated with initial depression nor changes in depression. Implications for intervention, theory, and research are discussed.

Measurement of Behavioral and Emotional Outcomes of Youth in Foster Care: Investigation of the Roles of Age and Placement Type

The Behavioral Assessment System for Children-2 (BASC-2) is used to assess behavioral and emotional outcomes for youth. Research providing evidence for use of the BASC-2 parent-report form historically has included biological parents reporting on their children (Reynolds and Kamphaus 2004). For youth residing in out-of-home placements through enrollment in foster care, caregivers reporting on their functioning may include foster parents or residential staff. Given the significant adverse mental health outcomes for youth in foster care and the need to adequately assess adjustment in foster care, the purpose of the study was to evaluate the measurement properties of caregivers' report on the parent report form (PRS) of the BASC-2 in foster care youth. Using 479 respondents, a measurement model was fit to the data demonstrating adequate fit across Internalizing Problems, Externalizing Problems, and Adaptive Skills. Further, a comparison of measurement properties across child and adolescent groups and groups of youth residing in residential facilities versus foster homes was conducted. Factorial invariance and latent means also were assessed. The BASC-2 PRS was found to be an adequate assessment of psychological outcomes for youth in foster care when completed by foster parents or residential facility staff.

Effects of a structural intervention and implementation on physical activity among youth in residential children's homes

This study reports the effects of a structural intervention, ENRICH (Environmental Interventions in Children's Homes) which targeted the physical and social environment within residential children's homes (RCHs) to increase physical activity (PA) among residents (n=799). Participating RCHs (n=29) were randomized to Early (n=17) or Delayed (n=12) groups from 2004 to 2006 and 2006 to 2008, respectively. Children's PA was measured at three time periods (2004, 2006, 2008). Intent-to-treat analysis revealed no intervention impact on PA. Subsequent analyses used process evaluation data to group organizations into high and low PA-promoting RCHs to compare PA level, controlling for assignment to condition. Organizations with high PA-promoting environments were found to have more active youth. Utility of a comprehensive implementation monitoring plan and the need for formative assessment of organizational capacity is discussed.

Psychosocial pathways to sexually transmitted infection risk among youth transitioning out of foster care: evidence from a longitudinal cohort study

PURPOSE

To test the fit of a theoretically driven conceptual model of pathways to sexually transmitted infection (STI) risk among foster youth transitioning to adulthood. The model included (1) historical abuse and foster care experiences; (2) mental health and attachment style in late adolescence; and (3) STI risk in young adulthood.

METHODS

We used path analysis to analyze data from a longitudinal study of 732 youth transitioning out of foster care. Covariates included gender, race, and an inverse probability weight. We also performed moderation analyses comparing models constrained and unconstrained by gender.

RESULTS

Thirty percent reported they or a partner had been diagnosed with an STI. Probability of other measured STI risk behaviors ranged from 9% (having sex for money) to 79% (inconsistent condom use). Overall model fit was good (Standardized Root Mean Square Residual of .026). Increased risk of oppositional/delinquent behaviors mediated an association between abuse history and STI risk, via increased inconsistent condom use. There was also a borderline association with having greater than five partners. Having a very close relationship with a caregiver and remaining in foster care beyond age 18 years decreased STI risk. Moderation analysis revealed better model fit when coefficients were allowed to vary by gender versus a constrained model, but few significant differences in individual path coefficients were found between male and female-only models.

CONCLUSIONS

Interventions/policies that (1) address externalizing trauma sequelae; (2) promote close, stable substitute caregiver relationships; and (3) extend care to age 21 years have the potential to decrease STI risk in this population.

Substance Use Among Current and Former Foster Youth: A Systematic Review

Substance use tends to escalate across adolescence and into young adulthood, and can be intensified by experiences with trauma and maltreatment, mental illness, and exposure to parental alcohol and drug use. Despite the disproportionately high levels of these variables among youth placed in the foster care system, relatively few studies have focused on the measurement of substance use in this vulnerable population. The current review summarizes the published literature on alcohol and drug outcomes for current and former foster youth. Specifically, prevalence of use and diagnoses are presented separately, as well as a review of risk and protective factors. Discussion of results addresses limitations and suggestions for improvement in the measurement of these outcome variables.