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A Descriptive Analysis of Long-Term Treatment with Adolescent-Aged Foster Youth

  • Saralyn Carola Ruff
  • Chloe L. Jones
  • June Madsen Clausen
ORIGINAL ARTICLE

Abstract

Foster youth experience a complex combination of psychological symptoms associated with the experience of abuse and/or neglect. Among adolescents, psychological challenges can be magnified by an increased likelihood of placement disruption once in foster care, longer stays in the system, and numerous barriers that impede access and use of mainstream psychological intervention. This manuscript relies on two studies to learn more about the experience of adolescent-aged foster youth who utilize long-term mental health services coordinated through A Home Within, a national nonprofit committed to reducing treatment barriers by asking licensed therapists to provide pro bono therapy “for as long as it takes.” Study 1 evaluates 84 therapist interviews about client demographics, trauma history, and mental health symptoms in an effort to learn more about the concerns and experiences of adolescent-aged youth participating in treatment. Study 2 examines 30 pre/post interviews with therapists to understand outcomes associated with treatment completion, as well as to describe treatment practices. Findings support a need for continued investigation of long-term psychotherapeutic services with foster youth focused on the needs of youth accessing care and best treatment practices with this population of vulnerable youth.

Keywords

Adolescent therapy Foster care Mental health Psychology 

Notes

Acknowledgments

The authors wish to thank the clinicians and staff of A Home Within who participated in this evaluation study and the student researchers of the Foster Care Research Group who conducted interviews and data entry.

Compliance with Ethical Standards

Conflict of Interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical Standards and Informed Consent

“All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation [institutional and national] and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all participants included in the study.”

References

  1. American Academy of Pediatrics (AAP), Task Force on Health Care for Children in Foster Care. (2005). Health care for children and adolescents in foster care (2nd ed.). District II, New York: AAP.Google Scholar
  2. American Psychological Association (APA), & Presidential Task Force on Evidence-Based Practice. (2006). Evidence-based practice in psychology. American Psychologist, 61(4), 271–285.  https://doi.org/10.1037/0003-066X.61.4.271.CrossRefGoogle Scholar
  3. Baker, A. J., Brown, E. J., Schneiderman, M., Sharma-Patel, K., & Berrill, L. M. (2014). Application of evidence-based therapies to children in foster care: A survey of program developers. American Professional Society on the Abuse of Children Advisor, 27(1), 27–34.Google Scholar
  4. Brown, B. B. (2004). Adolescents' relationships with peers. In R. M. Lerner & L. Steinberg (Eds.), Handbook of adolescent psychology (second ed.). Hoboken, NJ: John Wiley & Sons, Inc..  https://doi.org/10.1002/9780471726746.ch12.CrossRefGoogle Scholar
  5. Burns, B., Phillips, S., Wagner, H., Barth, R., Kolko, D., Campbell, Y., & Landsverk, J. (2004). Mental health need and access to mental health services by youths involved with child welfare: A national survey. Journal of the American Academy of Child and Adolescent Psychiatry, 43, 960–970.  https://doi.org/10.1097/01.chi.0000127590.95585.65.CrossRefPubMedGoogle Scholar
  6. Chaffin, M., & Friedrich, B. (2004). Evidence-based treatments in child abuse and neglect. Children and Youth Services Review, 26, 1097–1111.  https://doi.org/10.1016/j.childyouth.2004.08.008.CrossRefGoogle Scholar
  7. Chamberlain, P., Moreland, S., & Reid, K. (1992). Enhanced services and stipends for foster parents: Effects on retention rates and outcomes for children. Child Welfare, 71(5), 387–401.PubMedGoogle Scholar
  8. Clausen, J. M., Ruff, S. C., vonWiederhold, W., & Heineman, T. (2012). For as long as it takes: Relationship-based play therapy for children in foster care. Psychoanalytic Social Work, 19, 43–53.  https://doi.org/10.1080/15228878.2012.666481.CrossRefGoogle Scholar
  9. Cohen, J. A., Mannarino, A. P., & Iyengar, S. (2011). Community treatment of posttraumatic stress disorder for children exposed to intimate partner violence: A randomized con-trolled trial. Archives of Pediatrics and Adolescent Medicine, 165(1), 16–21.  https://doi.org/10.1001/archpediatrics.2010.247.CrossRefPubMedGoogle Scholar
  10. Cook, A., Spinazzola, J., Ford, J., Lanktree, C., Blaustein, M., Cloitre, M., et al. (2005). Complex trauma in children and adolescents. Psychiatric Annals, 35(5), 390–398.CrossRefGoogle Scholar
  11. Courtney, M. E., Piliavin, I., Grogan-Kaylor, A., & Nesmith, A. (2001). Foster youth transitions to adulthood: A longitudinal view of youth leaving care. Child Welfare, 80(6), 685–717.PubMedGoogle Scholar
  12. Delaney, L., & Smith, J. P. (2012). Childhood health: Trends and consequences over the life course. Future of Children, 22(1), 43–63.  https://doi.org/10.1353/foc.2012.0003.CrossRefPubMedGoogle Scholar
  13. Farruggia, S. P., & Sorkin, D. H. (2009). Health risks for older US adolescents in foster care: The significance of important others’ health behaviours on youths’ health and health behaviours. Child: Care, Health, and Development, 35(3), 340–348.  https://doi.org/10.1111/j.1365-2214.2009.00960.x.CrossRefGoogle Scholar
  14. Fisher, P. A., Gunnar, M. R., Chamberlain, P., & Reid, J. B. (2000). Preventive intervention for maltreated preschool children: Impact on children's behavior, neuroendocrine activity, and foster parent functioning. Journal of the American Academy of Child and Adolescent Psychiatry, 39(11), 1356–1364.  https://doi.org/10.1097/00004583-200011000-00009.CrossRefPubMedGoogle Scholar
  15. Florsheim, P., Shotorbani, S., Guest-Warnick, G., Barratt, T., & Hwang, W. C. (2000). Role of the working alliance in the treatment of delinquent boys in community-based programs. Journal of Clinical Child Psychology, 29(1), 94–107.  https://doi.org/10.1207/S15374424jccp2901_10.CrossRefPubMedGoogle Scholar
  16. Galehouse, P., Herrick, C., & Raphel, S. (2010). Position statement on foster care international society of psychiatric-mental health nurses. Journal of Child and Adolescent Psychiatric Nursing, 23(1), 36–40.  https://doi.org/10.1111/j.1744-6171.2009.00215.x.CrossRefPubMedGoogle Scholar
  17. Garcia, A., & Courtney, M. (2011). Prevalence and predictors of service utilization among racially and ethnically diverse adolescents in foster care diagnosed with mental health and substance abuse disorders. Journal of Public Child Welfare, 5(5), 521–545.  https://doi.org/10.1080/15548732.2011.617277.CrossRefPubMedPubMedCentralGoogle Scholar
  18. Garland, A. F., Hough, R. L., McCabe, K. M., Yeh, M., Wood, P. A., & Aarons, G. A. (2001). Prevalence of psychiatric disorders in youths across five sectors of care. Journal of the American Academy of Child & Adolescent Psychiatry, 40(4), 409–418.  https://doi.org/10.1097/00004583-200104000-00009.CrossRefGoogle Scholar
  19. Gilbertson, R., & Barber, J. (2002). Obstacles to involving children and young people foster care research. Child and Family Social Work, 7(4), 253–258.  https://doi.org/10.1046/j.1365-2206.2002.00251.x.CrossRefGoogle Scholar
  20. Greeson, J. K., Briggs, E. C., Kisiel, C. L., Layne, C. M., Ake, G. S., Ko, S. J., et al. (2011). Complex trauma and mental health in children and adolescents placed in foster care: findings from the National Child Traumatic Stress Network. Child Welfare, 90(6), 91–108.PubMedGoogle Scholar
  21. Havlicek, J., Garcia, A., & Smith, D. C. (2013). Mental health and substance use disorders among foster youth transitioning to adulthood: Past research and future directions. Child Youth Services Review, 35(1), 194–203.  https://doi.org/10.1016/j.childyouth.2012.10.003.CrossRefGoogle Scholar
  22. Heflinger, C. A., Simpkins, C. G., & Combs-Orme, T. (2000). Using the CBCL to determine the clinical status of children in state custody. Children and Youth Services Review, 22(1), 55–73 http://citeseerx.ist.psu.edu/viewdoc/summary?doi=10.1.1.468.4516.CrossRefGoogle Scholar
  23. Heineman, T. V., Clausen, J. M., & Ruff, S. (Eds.). (2013). Treating trauma: Relationship-based psychotherapy with children, adolescents, and young adults. Jason Aronson Publishing Company.  https://doi.org/10.13140/2.1.1941.6961.
  24. Hogue, A., Dauber, S., Stambaugh, L. F., Cecero, J. J., Liddle, H. A. (2006). Early therapeutic alliance and treatment outcome in individual and family therapy for adolescent behavior problems. Journal of Consulting Clinical Psychology, 74(1), 121–129.  https://doi.org/10.1037/0022-006X.74.1.121.CrossRefGoogle Scholar
  25. Horvath, A. O., Del Re, A. C., Flückiger, C., & Symonds, D. (2011). Alliance in individual psychotherapy. Psychotherapy (Chicago III), 48(1), 9–16.  https://doi.org/10.1037/a0022186 CrossRefGoogle Scholar
  26. Jackson, Y., Gabrielli, J., Tunno, A. M., & Hambrick, E. P. (2012). Strategies for longitudinal research with youth in foster care: A demonstration of methods, barriers, and innovations. Children and Youth Services Review, 34(7), 1208–1213.  https://doi.org/10.1016/j.childyouth.2012.02.007.CrossRefPubMedPubMedCentralGoogle Scholar
  27. Jacobs, M. A., Bruhn, C., & Graf, I. (2008). Methodological and validity issues involved in the collection of sensitive information from children in foster care. Journal of Social Service Research, 34(4), 71–83.  https://doi.org/10.1080/01488370802162517.CrossRefGoogle Scholar
  28. James, A., Soler, A., & Weatherall, R. (2005). Cognitive behavioural therapy for anxiety disorders in children and adolescents. Cochrane Database of Systematic Reviews, 4.  https://doi.org/10.1002/14651858.CD004690.pub2/abstract.
  29. Jewell, J. D., Brown, D. L., Smith, G., & Thompson, R. (2010). Examining the influence of caregiver ethnicity on youth placed in out of home care: Ethnicity matters-for some. Adolescents and Youth Review, 32(10), 1278–1284.  https://doi.org/10.1016/j.childyouth.2010.04.019.CrossRefGoogle Scholar
  30. Johnson, E., & Menna, R. (2017). Help seeking among adolescents in foster care: A qualitative study. Children and Youth Services Review, 76(C), 92–99.  https://doi.org/10.1016/j.childyouth.2017.03.002.CrossRefGoogle Scholar
  31. Kolko, D. J., Campo, J. V., Kelleher, K., & Cheng, Y. (2010). Improving access to care and clinical outcome for pediatric behavioral problems: A randomized trial of a nurse-administered intervention in primary care. Journal of Developmental & Behavioral Pediatrics, 31(5), 393–404.  https://doi.org/10.1097/DBP.0b013e3181dff307.CrossRefGoogle Scholar
  32. Kramer, D. N., & Landolt, M. A. (2011). Characteristics and efficacy of early psychological interventions in children and adolescents after single trauma: A meta-analysis. European Journal of Psychotraumatology, 2, 7858.  https://doi.org/10.3402/ejpt.v2i0.7858.CrossRefGoogle Scholar
  33. Landsverk, J. A., Burns, B. A., Stambaugh, L. F., & Reutz, J. A. R. (2009). Psychosocial interventions for children and adolescents in foster care: Review of research literature. Child Welfare, 88(1), 49–69.PubMedGoogle Scholar
  34. Levitt, J. M. (2009). Identification of mental health service need among youth in child welfare. Child Welfare, 88(1), 27–48.PubMedGoogle Scholar
  35. Ludy-Dobson, C., & Perry, B. D. (2010). The role of healthy relational interactions in buffering the impact of childhood trauma. In E. Gil (Ed.), Working with children to heal interpersonal trauma (pp. 26–44). New York: Guilford Press.Google Scholar
  36. McMillen, J. C., Zima, B. T., Scott, L. D., Auslander, W. F., Munson, M. R., Ollie, M. T., & Spitznagel, E. L. (2005). Prevalence of psychiatric disorders among older youths in the foster care system. Journal of the American Academy of Child & Adolescent Psychiatry, 44(1), 88–95.  https://doi.org/10.1097/01.chi.0000145806.24274.d2.CrossRefGoogle Scholar
  37. Mennen, F. E., Sang, K. K., & Trickett, P. K. (2010). Child neglect: Definition and identification of youth’s experiences in official reports of child maltreatment. Child Abuse & Neglect, 34(9), 647–658.  https://doi.org/10.1016/j.chiabu.2010.02.007.CrossRefGoogle Scholar
  38. Pecora, P. J., Jensen, P. S., Romanelli, L. H., Jackson, L. J., & Ortiz, A. (2009). Mental health service use for children placed in foster care: An overview of current challenges. Child Welfare, 88(1), 5–24.PubMedPubMedCentralGoogle Scholar
  39. Riebschelger, J., Day, A., & Damashek, A. (2015). Foster care youth share stories of trauma before, during, and after placement: Youth voices for building trauma-informed systems of care. Journal of Aggression, Maltreatment & Trauma, 24(4), 339–360.  https://doi.org/10.1080/10926771.2015.1009603.CrossRefGoogle Scholar
  40. Ruff, S. C., Aguilar, R. M., & Clausen, J. M. (2015). An exploratory study of mental health interventions with infants and young children in foster care. Journal of Family Social Work, 19(3), 184–198.  https://doi.org/10.1080/10522158.2016.1181128.CrossRefGoogle Scholar
  41. Ryan, N. D. (2005). Treatment of depression in children and adolescents. Lancet, 366, 933–940.  https://doi.org/10.1016/S0140-6736(05)67321-7.CrossRefPubMedGoogle Scholar
  42. Scozzaro, C., & Janikowski, T. P. (2015). Mental health diagnosis, medication, treatment and placement milieu of children in foster care. Journal of Child and Family Studies, 24, 2560–2567.  https://doi.org/10.1007/s10826-014-0058-6.CrossRefGoogle Scholar
  43. Snowden, L. R., Cuellar, A. E., & Libby, A. M. (2003). Minority youth in foster care: Managed care and access to mental health treatment. Medical Care, 41(2), 264–274.  https://doi.org/10.1097/01.MLR.0000044906.77195.8A.CrossRefPubMedGoogle Scholar
  44. Sohn, J. N., & Lee, Y. M. (2012). Effects of cognitive behavioral therapy program on mental health problems in children dealing with trauma: Focused on community district victimized by oil spill. Journal of Korean Academy of Nursing, 42(1), 56–65.  https://doi.org/10.4040/jkan.2012.42.1.56.CrossRefPubMedGoogle Scholar
  45. Stith, S. M., Liu, T. L., Davies, C., Boykin, E. L., Alder, M. C., Harris, J. M., et al. (2009). Risk factors in child maltreatment: A meta-analytic review of the literature. Aggression and Violent Behavior, 14(1), 13–29.  https://doi.org/10.1016/j.avb.2006.03.006.CrossRefGoogle Scholar
  46. United States Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children's Bureau. (2015). The adoption and Foster Care analysis and reporting system. Retried from: https://www.acf.hhs.gov/sites/default/files/cb/afcarsreport23.pdf
  47. Unrau, Y. A., Conrady-Brown, M., Zosky, D., & Grinnell, R. M. (2006). Connecting youth in foster care with needed mental health services: Lesson from research on help seeking. Journal of Evidence-Based Social Work, 3(2), 91–109.  https://doi.org/10.1300/J394v03n02_05.CrossRefGoogle Scholar
  48. Wagner, E. F., Swenson, C. C., & Henggeler, S. W. (2000). Practical and methodological challenges in validating community-based interventions. Children's Services: Social Policy, Research and Practice, 3(4), 211–231.  https://doi.org/10.1207/S15326918CS0304_2.CrossRefGoogle Scholar
  49. Ward, T. K. (2014). Adjustment differences in teenage children: Foster care versus group homes. Master of Social Work Clinical Research Papers. Paper 406. http://sophia.stkate.edu/msw_papers/406
  50. Weisz, J. R., McCarty, C. A., & Valeri, S. M. (2006). Effects of psychotherapy for depression in children and adolescent: A meta-analysis. Psychological Bulletin, 132, 132–149.  https://doi.org/10.1037/0033-2909.132.1.132.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  • Saralyn Carola Ruff
    • 1
  • Chloe L. Jones
    • 1
    • 2
  • June Madsen Clausen
    • 3
  1. 1.Psychology DepartmentUniversity of San FranciscoSan FranciscoUSA
  2. 2.Department of Psychological SciencesUniversity of ConnecticutStorrsUSA
  3. 3.School of Nursing and Health ProfessionsUniversity of San FranciscoSan FranciscoUSA

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