The Impact of Foster Care of Children`s Mental Health
The Impact of Foster Care of Children’sMental Health
Historically, foster care programs have beenadopted by various countries in the world. The notable examples ofthese countries the United States, India, Cambodia, the UnitedKingdom, Australia, Japan, Israel, and Canada. Notably, in the UnitedStates, the program came into existence through the efforts of LoringCharles Brace in mid 19thcentury, after witnessing the suffering of over 30,000 homelesschildren living in the slums and streets of New York. Loring took thechildren from the streets and placed them under the foster care offamilies across different states in the United States. Children wereparaded on stages, town halls, and train platforms and interestedfoster homes were allowed to choose whom to adopt (Schooler,Callahan, and Smalley, 2014). According to Fosterclub (2017), over120,000 children benefited from Brace’s Children Aid Societyinitiative. As Child welfare information gateway (2017) indicates,the children’s Aid Society was the basis for the enactment of theimplementation of Safe Families Act (Concurrent Planning) by thefederal government in 1997, which also led to the establishment offoster care for children. According to Schooler, Callahan, andSmalley (2014), the enactment by the Congress was vital to theexpansion of the foster care system. Schooler, Callahan, and Smalley(2014) note that many families and homes are characterized by one ormore of issues (reasons) that contribute this situation: parentalsubstance abuse, poverty, prolonged neglect, sexual abuse andphysical violence. This paper explores the impact of foster care onchildren’s mental health.
Overview of Foster Care System in the UnitedStates
Prevalenceof Children in Foster Care Systems in the United States
The number of children in the foster careprogram has been increasing gradually. For instance, a 4 percentincrement was witnessed between 2012 and 2014, in which, 415,129children were placed under foster care in the United States. In 2015,over 670 children are placed in foster care on any given day(California Child Welfare Co-Investment Partnership, 2014Fosterclub, 2017). The duration that the children spend under afoster family varies. Some children live in foster care for even overfive years, although the age of the majority of the children is nineyears old. Many children come from the minority communities. In 2015,about 264,746 children were recruited in foster care in the UnitedStates—translating to one child entering foster care in every twominutes (Fosterclub, 2017 U.S.Department of Health and Human Services, Administration for Childrenand Families, Administration on Children, Youth and Families,Children’s Bureau, 2015).
The population of minors in foster care hasincreased significantly across various states. Some of the factorscontributing to the high population include lack or fewer numbers ofpeople willing to adopt children, the increase in cases of childneglect and abuse, and increase in population and of needy and streetchildren (Child Welfare Information Gateway, 2017). For instance, inWashington, about 10,208 were relying on out-of-home-care in2013—representing a 2 percent increase in 2012. Nevertheless, 1,328of the children were adopted, accounting for about8.2 percentincrease compared to the statistics of 2012. Besides, in California,over 10,501 children were under foster care in 2014 (California ChildWelfare Co-Investment Partnership, 2014).
Types of Foster Care Placements
Group Homes are foster care facilities housingsix or more children until a permanent living solution isestablished. Initially, group homes were faced with various problemsattributed to lack of proper industry regulations and the shortage ofinformed or experienced operators. Children placed in Group Homesinclude victims of physical and sexual abuse and those neglected bytheir parents (Felitti,Anda, Nordenberg, Williamson, Spitz Edwards Koss and Marks, 2015).
In kinship care type of foster care placement,children are placed under the care of relatives or grandparents. Inmost cases, the process is undertaken informally—without theinvolvement of a public organization or court.
Foster Homes are facilities that are used tohouse thousands of children after confirmation that they cannot livesafely in their homes. Children are placed permanently under the careof foster parents.
FosterFamily Agency Homes
Unlikefoster homes run by the government, the family agency houses areestablished and run by the nongovernmental organizations.
Process of Placing Children in Foster Care
The Screening/Selection Team is tasked with theevaluation of the referral, planning and before making informeddecisions whether to recommend for placement of children.
In the assessment process, the Screening Teamreviews all necessary materials and conduct interviews on the youth,and the current therapist, caregiver, referring Children’s ServicePersonnel to establish whether the child is suitable for the fostercare program (Child Welfare Information Gateway, 2017). TheScreening/Selection Team may recommend one of the following (1) Thechild is appropriate and a suitable or compatible home is available(2) The child is appropriate, but there is no suitable foster carehome in the county of residence, and nearby counties, or (3)The childis not suitable or adequate for the foster care program.
The Licensing Worker will avail and assess theScreening Team’s referral report with any prospective parents todetermine their ability to provide for the needs of the child. TheChildren’s Service Representative and Screening Team will informthe case manager concerning the child’s acceptance into theprogram. Following a child’s placement into the program, theChildren’s Service representative or worker will: (1) Coordinateand plan with the county of origin in case the current arrangement isin a different county with the case manager’s county (2) Receiveall notifications regarding the availability of resources based onthe foster care regulations (California child welfare Co-Investmentpartnership, 2014).
Prevalence Rates of Behavioral HealthProblems
Childrenin the United States
The prevalence of mental disorders amongchildren in the United States is high. For instance,Attention-deficit disorder was the mostprevalent disorder with 6.8 percent among children between the age of3 and 17 years.
Table1: prevalence of mental disorders among children in the United States(Lehman,Havik, Havik and Heiervang, 2016)
Moreover, suicide rates for youths between 10and 19 years were 4.5 cases in every 100,000 youths in 2010.Additionally, about 8 percent of juveniles aged between 12 and 17years admitted to having over 14 mentally unhealthy days in onemonth.
ChildrenWithin Foster Care Systems in the United States
Lippman, Moore, McIntosh (2014)discuss that 33 percent of children infoster care programs have different mental disorders. This view wasexemplified by a study was conducted by Lehman,Havik, Havik, and Heiervang in 2013 inselected foster care facilities in the United States to determine theprevalence of mental conditions, risk factors and comorbidity inchildren between the age of 6 and 12 years. To arrive at informedinferences, information was collected from teachers, parents, 249foster care children using the Web-based Developmental and Well-BeingAssessment (DAWBA) diagnostic interview. 50.9 percent of the childrenhad one or more mental disorders. Common majority disorders were ADHD(19 percent), behavioral disturbances (21 percent) and emotionaldisturbances (24 percent). Besides, comorbidity rate was significantin three groups of common mental disorders that were arranged. Inparticular, 30.4 percent of the children had disorders in two of thethree diagnostic groups while 13 percent had mental illness cuttingacross all the three groups. Moreover, 19.4 percent of theparticipants had Reactive attachment disorders (RAD). Out of the 19.4 percent with RAD disorders, 58.5 percent had comorbid conditions intheir respective diagnostic groups. The mental illness was attributedto severe neglect, exposure to violence, and prior foster placements(Lehman, Havik, Havik and Heiervang,2016).
Impact of Foster Care on Children
The foster care has various benefits tochildren. One of the advantages is the healing process. The kids puton the care are those affected by stressing and overwhelmingchallenges such as bereavement and incarceration of parents.Therefore, part of the core goals of the foster care is to providethe necessary environment to allow the children to heal from suchstressing conditions.
The second benefit of a foster family is bettercare. Ideally, the primary goal of placing children under a fosterfamily is borne on the belief that when left to exist in adverseconditions, the children would not receive the best care. Only thefoster care program suffices the kids needs, and this is particularlybecause it is endowed with people to offer the needed assistance.
Lastly, the foster care provides theopportunities for education. Considering access to education as afundamental right, the vulnerable children may not be able to accesseducation because of the inherent social and economic limitations.The foster care program enables children to overcome the inherentchallenges (Rubin,O’Reilly, Luan & Localio, 2013).
Although the foster care has is lauded to bebeneficial, it has certain inherent concerns. In particular, theenvironment upon which children are exposed could trigger severalpsychological complications. These mental conditions could be causedby different factors, including the absence of the parent, the appealof the foster care environment to a child and the inability to copewith prior stressors. Various psychological complications have beennoted (Schooler, Callahan & Smalley, 2014). The mental conditionsthat could result from the absence of a parent include anxietydisorder, panic disorder, reduced and abnormal social skills,reactive attachment disorder and aggressiveness, among others. Themental conditions associated with the lack of an appealing fostercare environment for a child are depression, caring for infants,modified social phobia, impulsiveness, and anger. Besides, theexamples of depression associated the inability to cope with priorstressors are post-traumatic stress syndrome and low adaptivefunctioning (Johnson,Riley & Granger 2014).
Central to the present topic is the theory thatbehavior is shaped by the experiences that one has with theenvironment. In this case, the environment comprises of the physicaland social environment. As explained by Carl Rogers, under idealcircumstances, interactions with the environment often result inreshaping the perceptual fields that are eventually translated intothe self. In essence, the interaction with the environment generatesexperiences that are evaluated and subsequently integrated into thestructures of the self (PsychologistWorld, 2015). In this case, thestructures of the self can be seen as organized, but the dynamicpattern that carries the identity of a person. However, the tendencyof experiences to shape the perceptual field is subject toindividual’s personal interests and aspirations, especially how theexperiences can be seen to be relevant to the ability one’sinterests (Humphreys, Gleason, Drury, Miron, Nelson, Fox &Zeanah, 2015). Interactions with the environment can be problematic(Judith2012).
Treatment and Intervention of Mental andPsychological Conditions
Mental disorders are psychological conditionsthat are characterized by sufficient disorganization of emotions,mind, and personality. Mental illness often impair the normal socialand mental functioning of an individual. In many occasions, theyconsist of a combination of cognitive, behavioral, perceptual andaffective components. Conventional treatment methods for mentaldisorders include Electroconvulsive therapy, Psychiatric medication,Psychotherapy, Creative therapy, and Evidence-basedtreatments/Exemplary Programs (Robinson, Bitsko, Schieve &Visser, 2013).
Psychiatric medication involves the use oflicensed psychoactive drugs under the prescription of a family doctoror psychiatrist. Psychotropic drugs are grouped as Antidepressants,Anxiolytics, Mood stabilizers, Antipsychotics, and Stimulants.Firstly, Antidepressants are applied for the treatment of anxiety andclinical depression among other disorders. Secondly, Anxiolyticsdrugs are used for short-term purposes in the treatment of anxietydisorders, among other related conditions including insomnia andphysical symptoms. Nevertheless, Mood stabilizers are applied inbipolar disorders, particularly mania while Antipsychotics drugs areused for treating psychotic disorders such as schizophrenia. Smallerdoses of antipsychotic drugs are also used to treat anxiety. Finallyyet importantly, Stimulants are generally applied in the treatment ofdifferent mental disorders. However, prolonged use of Stimulants isassociated with adherence and adverse effects and complications(Child welfare information gateway, 2017).
Psychotherapy form of treatment for mentaldisorders is often carried out by mental health professionals(clinical psychologists) using specific techniques. Some of thesepsychotherapy techniques include Cognitivebehavioral therapy (CBT), Psychoanalysis, and Family therapy orSystematic therapy. For instance, Cognitive behavioral therapy isused on a broad range of disorders, relative to modification of thepatterns of behavior and thought accompanying a particular disease.It is also worth noting that various types of Cognitive behavioraltherapy exist, such as dialectical behavior therapy. The suitabilityof the technique applied to patients may vary depending on theapproach (either integrative or eclectic approach) and therapeuticrelationship (confidentiality, trust, and engagement) of theprofessional. However, some techniques such as social and rhythmtherapy are applied for specific mental disorders (Schooler,Callahan, and Smalley, 2014).
Electroconvulsive therapy is used when apatient does not respond to other forms of treatments. It entails theapplication of electric current to the patient for stimulation.Psychosurgery is a form of Electroconvulsive therapy that is used indeep brain stimulation (Garnerand Shonkoff, 2012).
Creative therapies involve the use ofsupportive measures and lifestyle adjustment to treat mentalconditions. These actions include peer support, supported housing andemployment, self-help, and dietary supplements. Some of the commonforms of Electroconvulsive therapy are art therapy, music therapy anddrama therapy (Thespruce, 2017).
Exemplary programs entail engaging in treatmentmodalities and use of available services for mental conditions basedin the communities, clinics or hospitals. Common excellent programsinclude psychosocial rehabilitation, Assertive Community Treatmentand early intervention programs, focusing challenging socialexclusion and stigma while instilling hope and creating empowerment.
Mental Health Service Utilization and Costs
Mental health services are under utilized inmany countries, especially in Africa due to the high cost oftreatment. In many low- andmiddle-income countries, the high cost of psychiatric treatment,often due to high medication prices, poses significant financialbarriers to patient care. In addition, psychological disorders arenot covered by insurance policies in many countries, making mentalhealth care unaffordable for many people. The WHO also reports that25% of all countries do not provide disability benefits to patientswith mental disorders, and one-third of the world’s populationlives in countries that allocate less than 1% of their health budgetto mental health. Furthermore, 31% of countries do not have aspecific public budget for mental health (Thespruce, 2017).
Addressing Barriers to Care
The barriers to care can be dealt with throughthree strategies: mode of care, therapeutic agents, andcommunity-based programs. Psychological disorders are very complex innature. Successful treatment of psychological disorders requiresdifferent support services and regular and frequent access to medicaland mental professionals (Woods, Farineau and McWey, 2013). However,services regarding psychiatric care are often under-utilized indeveloped countries, while the rarely available in developingcountries. It is also worth noting that in developed nations, thepercentage of people in need of mental treatment and care but do nothave access to treatment and care (treatment gap) is between 44 and70 percent. On the other hand, Humphreys, Gleason, Drury, Miron,Nelson, Fox, and Zeanah (2015) assert that the treatment and care gapmay be about 90 percent in developing countries and communities withlow socioeconomic status. Some of the common barriers are limitedaffordability and availability of services relating to mental healthcare, inadequate policies, and the minimal level of education andknowledge about mental illness, as well as the lack of funding.
The lack of knowledge and understanding of theneeds of patients with mental conditions is a common factor in manycountries. The limited knowledge on mental illness and needs canprevent children with psychological conditions from identifying theirmental needs and making adjustments. The caregivers and patients’families are also unable to provide the needed care for theirpatients. As Woods, Farineau, and McWey (2013) discuss, NationalComorbidity Survey data indicates that only 40 percent of individualswith critical mental conditions had access to a stable treatmentprogram.
Humphreys, Gleason, Drury, Miron, Nelson, Fox,and Zeanah (2015) note the ratio of trained professionals in mentalillness to the number of patients with mental illness is small.Despite the increasing number of patients with mental conditions andgovernment facilities to deal with such cases, the government needsto increase the ratio of medical professional significantly to caterfor all patients.
The lack of funding has incapacitated mentalhealth services and treatment. For instance, mental care facilitiesare unable to purchase different equipment and materials that arerequired for treatment of mental illness (Indyk, 2015). The workforcehas been trimmed despite a significant number of mental patientsneeding treatment. According to Humphreys, Gleason, Drury, Miron,Nelson, Fox, & Zeanah (2015), only about20 percent of thecountries across the world lack at least one of the essential mentalhealth management drugs such as antiepileptic, antidepressants, orantipsychotics.
The lack of comprehensive policies forcoordinating and implementing mental health care services has been asignificant barrier to access to efficient mental health care (Woods,Farineau, and McWey, 2013). Only a third of the countries across theworld have appropriate mental health care policies. Besides,centralization of main mental health facilities in the urban areaserved as a barrier for many patients from accessing medical careservices (Woods, Farineau & McWey2013).
The cost of mental treatment is a burden to themajority low and middle-income earners across the world. Besides, dueto the high cost of insurance cover, people with humble backgroundsare even finding it harder to access mental treatment (Woods,Farineau, and McWey, 2013 Sebba, 2013 Marotz, 2017).
As has been clearly revealed, the programs arefailing to realize the objectives of foster care for various reasons.The focus must be directed at building the resilience.Recommendations should mainly target the adoptive parents and thepolicymakers. The adoptive parents are advised to strive and createan environment that is conducive to the welfare of the childrenplaced under the programs. It has been noted that children developsome mental complications because of the lack of appropriate care andmaltreatment. In this regard, the foster care parents should identifythe areas of weaknesses within in practice and reform them.
Besides, the policymakers will need toundertake reforms within the practice. The significance of the changeis founded on the fact that certain aspects of the foster careprogram have an adverse impact on the children welfare, for instance,long placement under the care. The role of the policymakers will beto design the programs that are tailored to the needs of childrenplaced under foster care. It is hoped that these reforms would go along way in addressing the psychological and mental needs of childrenplaced in the foster care programs (Courtney,Dworsky, Brown, Cary, Love & Vorhies, 2013).
California Child Welfare Co-InvestmentPartnership (2014). Understandingdata and the child welfare.Retrieved fromhttp://co-invest.org/home/wp-content/uploads/Insights_0809.pdf
Child Welfare Information Gateway (2017). ChildWelfare/Foster Care Statistics.Retrieved fromhttps://www.childwelfare.gov/topics/systemwide/statistics/childwelfare-foster/
Courtney,M., Dworsky, A., Brown, A., Cary, C., Love, K., & Vorhies,V.,(2013) “Midwestevaluation of the adult functioning of former foster youth: Outcomesat age 26,”Chapin Hall at the University of Chicago. Retrieved fromwww.chapinhall.org/sites/default/files/Midwest%20Evaluation_Report_4_10_12.pdf.
FelittiVJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, KossMP. & Marks JS. (2015), “Relationship of childhood abuse andhousehold dysfunction to many of the leading causes of death inadults: the adverse childhood experiences (ACE) study,” AmericanJournal of Preventive Medicine,14:245–258.
Fosterclub (2017). Statisticson Foster Care. Retrieved fromhttps://www.fosterclub.com/article/statistics-foster-care
Garner,A., & Shonkoff, J., (2012). “Early Childhood Adversity, ToxicStress, and the Role of the Pediatrician: Translating DevelopmentalScience Into Lifelong Health. Pediatrics,”129: pp. e224-e231.
Humphreys, K. L., Gleason, M. M., Drury, S. S.,Miron, D., Nelson, C. A., Fox, N. A., & Zeanah, C. H. (2015).Effects of institutional rearing and foster care on psychopathologyat age 12 years in Romania: follow-up of an open, randomisedcontrolled trial. The LancetPsychiatry, 2(7),625-634.
Indyk,S. (2015). InformationPacket: Emotional and Psychological Well-Being of Children in FosterCare.Retrieved fromwww.chapinhall.org/sites/default/files/Midwest%20Evaluation_Report_4_10_12.pdf.
JohnsonSB, Riley, AW & Granger DA, (2014). “The Science of Early LifeToxic Stress for Pediatric Practice and Advocacy,” Pediatrics,2013,101: 319-327.
JudithS. (2012)., “Starting Young: Improving the Health and DevelopmentalOutcomes of Infants and Toddlers in the Child Welfare System,”Child Welfare 78 (1999): 148-165. See also Neal Halfon, et al.,“Health Status of Children in Foster Care,” Archivesof Pediatric and Adolescent Medicine 149:386-392.
Marotz, L. R. (2017). Parentingtoday`s children: A developmental prospective.S.l.: Wadsworth.
PsychologistWorld (2015). Whowas Sigmund Freud and how did his theories become so influential inpsychology?Retrieved fromhttps://www.psychologistworld.com/psychologists/sigmund-freud
RubinDM, O’Reilly A, Luan X, & Localio AR. (2013). “The Impact ofPlacement Stability on Behavioral Well-Being for Children in FosterCare,” Pediatrics,119(2):336-344. doi:10.1542/peds.2006-1995.
Schooler, J., Callahan, T., & Smalley, B.K. (2014). Wounded children, healinghomes: How traumatized children impact adoptive and foster families.Carol Stream, Ill: Tyndale House Publishers, Inc.
Sebba, J. (2013). TeamParenting for Children in Foster Care: A Model for IntegratedTherapeutic Care. Jessica KingsleyPublishers.
The Spruce (2017). WhatAre the Main Reasons Children Enter the Foster Care System?Retrieved fromhttps://www.thespruce.com/top-reasons-children-enter-foster-care-27123
U.S. Department of Health and Human Services,Administration for Children and Families, Administration on Children,Youth and Families, Children’s Bureau.(2015). ChildMaltreatment 2013: Reports from the States to the National ChildAbuse and Neglect Data System: Table3-2: Children Who Received anInvestigation or Alternative Response by Disposition, 2013.Retrievedfrom http://www.acf.hhs.gov/sites/default/files/cb/cm2013.pdf
Woods, S. B., Farineau, H. M., & McWey, L.M. (2013). Physical health, mental health, and behaviour problemsamong early adolescents in foster care. Child:care, health and development, 39(2),220-227.
Robinson LR, Bitsko RH, Schieve LA, Visser SN(2013). Tourette syndrome, parenting aggravation, and thecontribution of co-occurring conditions among a nationallyrepresentative sample. Disabil Health J6:26–35
Lippman LH, Moore KA, McIntosh H (2014).Positive indicators of child well-being: a conceptual framework,measures, and methodological issues. Appl Res Qual Life6:425–49.
Lehmann, S, Havik. O. E , Havik T andHeiervang E. R (2016). Child Adolescent psychiatry and mentalhealth. Retrieved fromhttps://capmh.biomedcentral.com/articles/10.1186/1753-2000-7-39
No related posts.