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.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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
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.
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.
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.
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.
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.
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.
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.
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.
Levitt, J. M. (2009). Identification of mental health service need among youth in child welfare. Child Welfare, 88(1), 27–48.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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
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.
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.
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
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.
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.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
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.”
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Ruff, S.C., Jones, C.L. & Clausen, J.M. A Descriptive Analysis of Long-Term Treatment with Adolescent-Aged Foster Youth. Journ Child Adol Trauma 12, 331–340 (2019). https://doi.org/10.1007/s40653-018-0233-9
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40653-018-0233-9