Improved Foster Care Reduces Risk Of Adult Mental And Physical Illness, Study Finds
http://www.sciencedaily.com/releases/2008/06/080602160721.htm
ScienceDaily (June 6, 2008) — In the first controlled follow-up study ever to examine the long-term
health effects of foster care programs, researchers from Harvard Medical School
showed that the extremely high rates of mental and physical disorders typically
found among adult alumni of public foster care programs were significantly
reduced among alumni of a private foster care program staffed by highly trained
social workers with low caseloads and good access to quality services.
The study followed 659 foster care alumni into adulthood more than a
decade after they left foster care. To make the comparisons meaningful, a
control group of state-run public system alumni was created consisting
exclusively of those eligible for, but not selected for, the private program
because of limited openings. The most dramatic differences were approximately
50 percent reductions in rates of adult major depression and substance use
disorders among private program alumni compared to the control group of public program alumni.
According to Ronald Kessler, Professor of Health Care Policy at
Calls for system redesign to improve care have resulted in a number of
public and private agencies developing foster care programs that offer higher
quality services, lower caseloads, and higher salaries for workers. Until now,
however, researchers have never systematically evaluated whether these program
quality improvements make a difference to youth outcomes. "The results of
this study show clearly that they make an enormous difference," says Kessler.
The study was carried out among alumni of foster care
programs in the states of Oregon and Washington in collaboration with state
agencies in Oregon (i.e., the Department of Human Services; Children, Adults
and Families; Community Human Services) and Washington (i.e., the Department of
Social and Health Services, Children's Administration, Division of Children and
Family Services) and Casey Family Programs (a private operating foundation
providing foster care services).
Case record files were used to select adolescents (14 to18 years of age)
who were in either the public or private programs in
Although there were many similarities in program experience and alumni
outcomes, significant differences were found in key
areas. Alumni from the
program with enhanced services:
Had significantly more stable placements in terms of
mean duration of placement than public program alumni--both
in
Were substantially less likely to experience adverse
events such as a reunification failure during comparable periods
of time in foster care.
Were also at consistently lower risk
of foster parent neglect, physical abuse, and sexual abuse.
The study team also found that alumni from the program with enhanced
services had significantly better outcomes than alumni from
the other programs in all measures of mental health and in some, but not
all, measures of physical health. Specifically, after adjusting for several
program differences, alumni from the higher quality program had a significantly
lower 12-month prevalence than alumni from the other programs in all three
classes of mental disorder studied, including major depression (11.3 percent
vs. 24.3 percent), anxiety disorders (28.8 percent vs. 43.0 percent), and
substance use disorders (5.1 percent vs. 11.1 percent). In addition:
When combined across classes of mental disorders,
alumni from the program with enhanced services had 44.7 percent fewer 12-month
disorders per 100 respondents than alumni from the other programs.
Alumni from the program with enhanced services also
had a significantly lower 12-month prevalence of ulcers (7.4 percent vs. 13.0
percent) and cardio metabolic conditions (including diabetes, hypertension, or
heart disease: 14.9 percent vs. 22.6 percent)
"These findings provide a wake-up call for the nation that the
well-being of hundreds of thousands of our most vulnerable children needs to
become a national priority," said Dr. Carol Spigner,
Kenneth L.M. Pray Professor in the School of Social Policy & Practice at
the
"We shortchange children in foster care
when we deny them the essential services that ultimately would enable them to
function in society as adults," said Dr. Carl Bell, President and C.E.O.
of the Community Mental Health Council in
Bob Butterworth, Secretary of the Florida Department of Children and
Families, added: "This study shows the tremendous benefits possible for
the children and families we serve if we can improve the care we give them. The
best way to do this in the face of flat budgets might be to reduce the number
of children in care and reinvest those savings into improving programs for the
children who remain in care."
Journal reference:
1.
Ronald C. Kessler, Ph.D., Peter J. Pecora,
Ph.D., Jason Williams, M.S., Eva Hiripi, M.A., Kirk
O'Brien, Ph.D., Diana English, Ph.D., James White, Ph.D., Richard Zerbe, Ph.D., A. Chris Downs, Ph.D., Robert Plotnick, Ph.D., Irving Hwang, M.A., Nancy A. Sampson, B.S.
Effects
of Enhanced Foster Care on the Long-Term Physical and Mental Health of Foster
Care Alumni. Archives of General Psychiatry, Vol. 65: No. 6, June
2008
Adapted from materials provided by Harvard Medical School, via EurekAlert!
, a service of AAAS.