Growing evidence has linked early trauma with severe psychiatric consequences. Posttraumatic stress disorder (PTSD) is a potentially debilitating mental health condition found among some youth in foster care and foster care alumni. However, the current child welfare practice response has not met the demands in both assessment and intervention. This critical review aims to use the evidence to reshape the child welfare response to trauma in children and adolescents. We begin with research on the psychiatric consequences of child maltreatment and issues related to diagnostic assessment for PTSD. Next, we compare major foster care/alumni studies showing considerably higher rates of PTSD among young foster care recipients and alumni than among nationally comparable groups. To inform practice on childhood trauma, we then summarize current evidence-based interventions showing effectiveness with PTSD. Finally, we address new dimensions, such as gene-environment research, posttraumatic growth, and implications for reshaping child welfare practice and foster care.
This study examined a path model that postulated intergenerational relationships between biological parent psychosocial functioning and foster care alumni mental health, economic status, and social support; and from these to the likelihood of children of foster care alumni being placed in foster care. The sample included 742 adults who spent time in foster care as children with a private foster care agency and who reported having at least one biological child. A full pathway was found between poorer father’s functioning to greater alumni depression, which was in turn associated with negative social support, and then a greater likelihood of child out of home placement. Other parent to alumni paths were that poorer father functioning was associated with alumni anxiety and PTSD, and poorer mother’s mental health was associated with PTSD; however, anxiety and PTSD were not implicated as precursors of foster care placement of the child. Findings support the need for increased practice and policy support to address the mental health needs of parents of children in or at risk of foster care, as well as the children themselves, as family history may have a lasting influence on quality of life, even when children are raised apart from biological parents.
This study identifies the prevalence of mental health comorbidity in a large multistate foster care alumni sample as well as early childhood and trauma-related predictors of comorbidity. Secondary analysis of case record and interview data for 1,038 alumni served by Casey Family Programs in 13 states were used to assess pre-foster care, during foster care, and post-foster care predictors of comorbidity, defined as 2 or Ն3 mental health conditions. Findings indicate that 9.8% of alumni had 2 mental disorders and 10.4% had Ն3 disorders. Multivariable analyses show that alumni who were female, lived below the poverty line, and who were unmarried were more likely to have comorbid mental disorders. Controlling for these significant factors, alumni who had childhood behavioral disorders or who were maltreated during foster care were more likely to have comorbid mental diagnoses. Alumni who perceived their foster parents as helpful some or a lot compared with a little had less comorbidity. The prevalence of comorbidity in this adult foster care alumni sample is higher than youth still in foster care and adults in the general population. This research highlights the need to prevent trauma-related interpersonal violence within foster families and ensure alumni access to health-care provisions long after they exit foster care. Recommendations focus on the need for comprehensive mental health assessments and quality treatment that addresses multiple conditions. Future research examining the effects of alumni mental health and treatment access on intergenerational outcomes is also recommended.
Objectives Little is known about prevention-focused counseling health providers deliver to parents of adolescents. This study compared parental report of discussions with their adolescents’ providers about a range of adolescent prevention topics. Methods Between June and November 2009, a questionnaire was provided to parents accompanying adolescents aged 11-18 on outpatient clinic visits. Parents indicated, anonymouslym which of 22 prevention topics they remembered discussing with their adolescent's provider. Hierarchical logistic regression models were used to identify correlates of parental recall. Results Among the 358 participants, 83% reported discussing at least one prevention topic. More parents reported discussing general prevention topics than mental health or high-risk topics (e.g. sex). Adolescent gender, visit type, having a usual source of care, and parental beliefs about their adolescents’ risk behaviors correlated with parental report of discussions about high-risk and mental health topics. Conclusion Most parents recalled discussing one or more topics with their adolescent's health provider. However, parental report of discussions about topics linked to significant adolescent morbidity was low. Practice implications Strategies to improve the frequency, timeliness and appropriateness of counseling services delivered to parents about adolescent preventive health are needed. Strategies that utilize decision support tools or patient education tools may be warranted.
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