Placement Stability and Mental Health Costs for Children in Foster Care

Rubin, David M.; Alessandrini, Evaline A.; Feudtner, Chris; Mandell, David S.; Localio, A. Russell; Hadley, Trevor R.

doi:10.1542/peds.113.5.1336

Cited by 212 publications

(96 citation statements)

References 48 publications

(54 reference statements)

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“…It is striking that more than half of youths who were in foster care at admission were moved to another placement at discharge. These findings are consistent with other research (Newton, Litrownik, & Landsverk, 2000;Rubin et al 2004) that has found higher rates of mental health problems associated with unstable foster care placements.Another important finding was the effect of hospital provider on readmission. Rates of readmission varied significantly across hospital providers, ranging from 28% to 48%.…”

supporting

confidence: 92%

The influence of clinical, treatment, and healthcare system characteristics on psychiatric readmission of adolescents.

Fontanella

2008

American Journal of Orthopsychiatry

103

124

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This study examined predictors of readmission for a sample of 522 adolescents enrolled in Medicaid and admitted to three inpatient psychiatric hospitals in Maryland. Comprehensive data on clinical, treatment, and health care system characteristics were collected from archival sources (medical records, Medicaid claims, and Area Resource File). Predictors of readmission were examined with bivariate (Kaplan Meier) and multivariate (Cox Regression) survival techniques. One year readmission rates were 38% with the majority occurring within 3 months after discharge. Adolescent demographic (age and gender), clinical (severity of symptoms, comorbidity, suicidality) and family characteristics (level of family risk) were associated with readmission. However, treatment factors including type of aftercare, post-discharge living environment, medication noncompliance, and hospital provider were among the strongest predictors of readmission. Study findings underscore the importance of careful discharge planning and linkage to appropriate aftercare. The differing rates of readmission across hospitals also suggest that organizational level factors may play a vital role in determining treatment outcomes. Keywords inpatient psychiatric hospitalization; adolescents; readmissionIt is estimated that 24% to 37% of youths will be readmitted to a psychiatric hospital within one year after discharge, and latest data suggest that rates of readmission are increasing despite cost-containment efforts and emphasis on community-based treatment alternatives (Blader, 2004;Fontanella, Zuravin, & Burry, 2006;Pavkov, Goerge, Lee, & Howard, 1994; Soloman, Evans, & Delaney, 1993). In the United States, inpatient services account for about 33% ($3.9 billion) of the total mental health expenditures for children and adolescents; across age groups adolescents are the highest users of inpatient services (Ringel & Sturm, 2001).Some researchers speculate that the increased readmission rates can be attributed to premature discharges resulting from shortened lengths of stay (Appley, Desai, Luchins, Gibbons, & Hedeker, 1993;Lien, 2002;Wickizer, Lessler, & Boyd-Wickizer, 1999). In fact, studies on Medicaid populations (Callahan, Shepard, Beinecke, Larson, & Cavanaugh, 1995;Dickey, Normand, Norton, Rupp, & Azeni, 2001;Saunders & Heflinger, 2003) have shown increasesCorrespondence concerning this article should be addressed to Cynthia A. Fontanella, College of Social Work, The Ohio State University, 1947 College Road, Columbus, Ohio 43210. E-mail: fontanella.4@osu.edu. Publisher's Disclaimer: The following manuscript is the final accepted manuscript. It has not been subjected to the final copyediting, fact-checking, and proofreading required for formal publication. It is not the definitive, publisher-authenticated version. The American Psychological Association and its Council of Editors disclaim any responsibility or liabilities for errors or omissions of this manuscript version, any version derived from this manuscript by NIH, or other third parties. ...

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supporting

confidence: 92%

The influence of clinical, treatment, and healthcare system characteristics on psychiatric readmission of adolescents.

Fontanella

2008

American Journal of Orthopsychiatry

103

124

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“…Happy, wanted, safe, loved and listened to. This is certainly not to discount the definitions used in previous studies -such as reunification (Brown & Campbell, 2007) or specific and measurable outcomes such as the child's health (Rubin, et al, 2004). However one can presume that if all of the children's criteria for success as highlighted in this study are achieved, then it is more likely that the other measures of success would naturally follow.…”

Section: Discussionmentioning

confidence: 91%

“…Some view success in terms of a positive reunification of the child with their original family (Brown & Campbell, 2007), but perhaps the most commonly agreed requirement for success is placement stability. There is widespread agreement on the disruptive nature of placement moves on foster children (Unrau, Seita, & Putney, 2008;Webster, Barth, & Needell, 2000) and placement stability has been linked to a an increased likelihood of positive outcomes for foster children including behavioural well-being (Rubin, et al, 2007), psychosocial wellbeing (Barber & Delfabbro, 2003) and mental health (James, 2004;Rubin, et al, 2004).…”

Section: Introductionmentioning

confidence: 99%

Through the Eyes of Ex-Foster Children: Placement Success and the Characteristics of Good Foster Carers

Randle¹

2013

Practice

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Randle, M. (2013). Through the eyes of ex-foster children: placement success and the characteristics of good foster carers. Practice: social work in action, 25 (1), 3-19. Through the eyes of ex-foster children: placement success and the characteristics of good foster carers AbstractMost research focusing on foster placement success or the characteristics of good foster carers is based on the opinions of people currently involved in the foster care system, such as foster carers, social workers or children in care. The few studies which include former foster children usually collect factual (usually quantitative) data to evaluate their pathways or achievements since leaving care, such as educational attainment or employment. This study differs because it examines the perceptions and opinions of adults who were in foster care as children, in relation to the important issues of what constitutes successful foster placement and the characteristics of the foster carers who are most likely to be able to make possible such a placement. For the most part, a successful placement is described by participants in terms of how they feel when they are therehappy, wanted, loved, listened to and safe. As well as the more commonly known characteristics of good foster carers, ex-foster children nominate important attributes as fun-loving, good-listeners and honest. This new perspective adds an important dimension to what we know about foster placement success and should be taken into consideration when making decisions about the delivery of foster care programmes.

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“…Prior studies link foster care instability with behavioral issues (Rubin et al, 2004;Rubin, O'Reilly, Luan, and Localio, 2007). If behavioral issues lead to instability (or instability leads to behavioral issues), it explains why children with complex careers are more likely to enter treatment care even though they enter foster care at a young age.…”

Section: Foster Care Careersmentioning

confidence: 99%

“…A number of studies documents the mutually reinforcing process of negative behavioral patterns and foster care instability (e.g., Newton, Litrowik, and Landsverk, 2000;Rubin et al, 2004;Rubin, O'Reilly, Luan, and Localio, 2007). Yet the data used does not allow me to examine important characteristics of the children.…”

Section: Limitationsmentioning

confidence: 99%

Identifying divergent foster care careers for Danish children

Fallesen

2014

Child Abuse & Neglect

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Foster care children who experience placement disruption and foster care instability are at elevated risk for a host of poor outcomes, yet little work considers what these unstable foster care careers look like or what causes them. In this article, I start by using previous studies on foster care drift, instability, and placement disruptions to define the unstable foster care career as a subset of foster care careers. I then use administrative data on 30,239 Danish children born 1982-1987 who entered foster care to generate nine foster care careers, two of which meet the criteria for an unstable career. Children with a high number of risk factors associated with foster care entry were also the most likely to enter an unstable career. I end by discussing implications for recent studies of the effect of foster care on children's later life outcomes and the relevance of the findings for practitioners.Keywords: administrative data; foster care; instability; sequence analysis 3 Foster care is intended to provide children with the best possible opportunity for personal development and stability when their immediate family is unable to secure them a safe and stable upbringing. Nevertheless, some children's placement trajectories end up mirroring the instability they experienced prior to entering foster care (e.g., Andersen, 2012; Havlicek 2011). Previous studies have examined aspects of such unstable foster care trajectories, including foster care drift where children move aimlessly through the foster care system, without reaching a permanent placement, adoption, or successful reunification (e.g., Andersen, 2012;Hartley, 1984)

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Placement Stability and Mental Health Costs for Children in Foster Care

Cited by 212 publications

References 48 publications

The influence of clinical, treatment, and healthcare system characteristics on psychiatric readmission of adolescents.

The influence of clinical, treatment, and healthcare system characteristics on psychiatric readmission of adolescents.

Through the Eyes of Ex-Foster Children: Placement Success and the Characteristics of Good Foster Carers

Identifying divergent foster care careers for Danish children

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