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CORK Bibliography: Foster Care

75 citations. January 2000 to present

Prepared: March 2012

Alpert LT. Research review: Parents' service experience - A missing element in research on foster care case outcomes. Child & Family Social Work 10(4): 361-366, 2005. (28 refs.)

A large body of child protection literature focuses on termination of parental rights, family reunification, and children's re-entry into care as outcomes for children in foster care. Studies have investigated child, placement, family, and parent variables as predictors of case outcome. However, one important group of variables remains largely unstudied: factors related to parents' service experience. Parents' service experience includes parents' perceptions of and involvement in the various services in which they must participate in order to recover their children from foster care (e.g. mandated treatment programmes such as substance abuse rehabilitation, parenting skills classes, etc.). The parental perspective on the foster care process is a critical element in the life of a child protection case, and its influence on case outcome must be explored. A brief review of the current literature on case outcome predictors is provided and parents' service experience is highlighted as an area in need of investigation. Suggestions for the measurement of parents' service experience are also offered.

Copyright 2005, Blackwell Publishing

Antle BF; Johnson L; Barbee A; Sullivan D. Fostering interdependent versus independent living in youth aging out of care through healthy relationships. Families in Society 90(3): 309-315, 2009. (47 refs.)

Although the child welfare system has historically provided "independent living" services, youth aging out of foster care are at increased risk of negative outcomes such as poverty, substance abuse, and homelessness. This manuscript builds upon the recent shift to "interdependent livings" approaches by describing skills for various stages of relationships, including the youth's relationship with their caseworker and foster family, centering around the need to define clear expectations and model healthy relationship skills. Youth must recognize their risk patterns and need for professional support, and develop educational/vocational goals for mentoring. Future relationships often include reconnecting with birth families and dating/romantic relationships, requiring an exploration of physical and emotional safety and establishment of healthy patterns for life-long relationships.

Copyright 2009, Alliance for Children & Families

Astley SJ; Stachowiak J; Clarren SK; Clausen C. Application of the fetal alcohol syndrome facial photographic screening tool in a foster care population. Journal of Pediatrics 141(5): 712-717, 2002. (25 refs.)

We determined the prevalence of fetal alcohol syndrome (FAS) in a foster care population and evaluated the performance of the FAS Facial Photographic Screening Tool. All children enrolled in a Washington State Foster Care Passport Program were screened for three conditions: (1) the FAS facial phenotype from a photograph, (2) evidence of brain damage with prenatal alcohol exposure from their Health and Education passport, and/or (3) other syndromes identifiable from a facial photograph. Screen-positives received diagnostic evaluations at a FAS Diagnostic and Prevention Network clinic. The prevalence of FAS in this foster care population was 10 to 15/1000, or 10 to 15 times greater than in the general population. The screening tool performed with 100% sensitivity, 99.8% specificity, 85.7% predictive value positive, and 100% predictive value negative. We conclude that the foster care population is a high- risk population for FAS. The screening tool performed with very high accuracy and could be used to track FAS prevalence over time in foster care to accurately assess the effectiveness of primary prevention efforts.

Copyright 2002, Mosby-Year Book, Inc.

Backovic D; Marinkovic JA; Grujic-Sipetic S; Maksimovic M. Differences in substance use patterns among youths living in foster care institutions and in birth families. Drugs: Education, Prevention and Policy 13(4): 341-351, 2006. (27 refs.)

Aim: The aim of this study was to determine differences in psychosocial context of occurrence of cigarette smoking and alcohol and drugs use between adolescents living in foster homes and those living with parents. Methods: The study examined 58 adolescents (14 - 17 years) living in foster homes and 245 living with parents using an anonymous questionnaire. Findings: Consumption of tobacco and cannabis was more common in the group of children living in foster homes. They tried these substances earlier and used them more frequently. The most important predictor for current smoking was the number of peers who smoked. Another important predictor of current smoking was an expressed feeling of loneliness. The studied groups did not differ significantly in the occurrence of alcohol drinking. Conclusions: These results suggest that suitable prevention programmes with emphases on social groups living under adverse conditions are needed. Further research should be conducted to give more detailed insight into the reasons and psychosocial factors that precipitate the start and perpetuation of these habits in diverse environments.

Copyright 2006, Taylor & Francis

Barth RP. Research outcomes of prenatal substance exposure and the need to review policies and procedures regarding child abuse reporting. Child Welfare 80(2): 275-296, 2001. (47 refs.)

Research on the outcomes of drug-exposed children evinces elevated developmental risks from the interaction of subtle biological vulnerabilities and compromised parenting. States, however, have generally not reviewed the procedures and policies they developed in the early 1990s when there was less research and experience with these children. At that time the gravest risks related to perinatal substance exposure seemed to be excessively punitive treatment of mothers by overzealous criminal justice prosecutors. This article clarifies policy options for reporting and serving children who are born testing positive for controlled substances and also calls for strengthening existing state policies regarding child abuse reporting and response.

Copyright 2001, Child Welfare League of America

Beeghly M; Frank DA; Rose-Jacobs R; Cabral H; Tronick E. Level of prenatal cocaine exposure and infant-caregiver attachment behavior. (review). Neurotoxicology and Teratology 25(1): 23-38, 2003. (113 refs.)

The objective of this longitudinal prospective cohort study was to determine whether level of prenatal cocaine exposure, or the interaction between level of prenatal cocaine exposure and contextual risk variables, was associated with a higher rate of infant-caregiver insecure attachment and disorganized attachment, or with alterations in infant crying or avoidant behavior, after controlling for prenatal exposure to alcohol, tobacco, and marijuana, the quality of the proximal caregiving environment, and other covariates. Subjects were 154 full-term 12-month-old infants (64 unexposed, 61 with lighter cocaine exposure, 29 with heavier cocaine exposure) and their primary caregivers from low-income, urban backgrounds. Exposure status was determined in the maternity ward by biologic assay (infant meconium and/or maternal or infant urine) and maternal self-report. At the 12-month follow-up visit, infants were videotaped with their primary caregiver in Ainsworth's Strange Situation. Reliable coders masked to exposure status scored videotapes for attachment variables, amount of crying, and level of avoidance. Contrary to popular perceptions, level of prenatal cocaine exposure was not significantly related to secure/insecure attachment status, disorganized attachment status, or rated level of felt security. Foster care status also was not associated with attachment status. However, heavier prenatal cocaine exposure, in interaction with maternal contextual variables (public assistance or multiparity) was associated with alterations in infant socio-affective behavior, including a higher level of behavioral disorganization, more avoidance of the caregiver, and less crying.

Copyright 2003, Pergamon Press

Blome WW; Shields J; Verdieck MJ. The association between foster care and substance abuse risk factors and treatment outcomes: An exploratory secondary analysis. Journal of Child & Adolescent Substance Abuse 18(3): 257-273, 2009. (34 refs.)

The child welfare and substance abuse systems are integrally linked through the children and families they both serve. There is a dearth of knowledge, however, on how children who have experienced foster care fare when they are treated for substance abuse issues as adults, This article presents an exploratory study using the Alcohol and Drug Services Study (ADSS) data set. To pursue a set of exploratory questions, adults in substance abuse treatment who were formerly in foster care were matched with a group who had not experienced substitute care. Their experiences before and after treatment were compared. This article presents the methodological and substantive findings.

Copyright 2009, Haworth Press

Brown JV; Bakeman R; Coles CD; Platzman KA; Lynch ME. Prenatal cocaine exposure: A comparison of 2-year-old children in parental and nonparental care. Child Development 75(4): 1282-1295, 2004. (56 refs.)

Effects of prenatal cocaine exposure and parental versus nonparental care on outcome at 2 years of age were examined. The sample included 83 cocaine-exposed and 63 nonexposed children and their caregivers; 49 and 34 of the cocaine-exposed children experienced parental and nonparental care, respectively. Prenatal drug exposure was not related directly to children's outcome at 2 years of age. However, compared with cocaine-exposed children in parental care, those in nonparental care experienced a more optimal environment and performed better in several developmental domains at 2 years of age in spite of being at greater neonatal risk. Further analyses suggested that this protective effect of nonparental care was in part due to nonkin rather than kin care.

Copyright 2004, Blackwell Publishers

Burrus SWM; Mackin JR; Finigan MW. Show me the money: Child welfare cost savings of a family drug court. Juvenile and Family Court Journal 62(3): 1-14, 2011. (27 refs.)

Family drug courts are programs that serve the complex needs of families involved with the child welfare system due to parental substance abuse. This article summarizes the results of outcomes and selected costs of a system-wide reform located in Baltimore, Maryland. Results from this study found that parents served by the program entered treatment faster, stayed in treatment longer, and completed treatment more often than non-served parents. Children in program families spent less time in foster care and were more likely to be reunified with their biological parents. These outcomes resulted in cost savings, including reduced foster care expenditures.

Copyright 2011, Wiley-Blackwell

Carter VB. Factors predicting placement of urban American Indian/Alaskan Natives into out-of-home care. Children and Youth Services Review 32(5): 657-663, 2010. (52 refs.)

American Indian/Alaskan Native children have disproportionately been placed into out-of-home care compared to White children in the child welfare system What were the factors that child protective set vices (CPS) workers considered when deciding to remove a child from the home? Utilizing data from the National Survey of Child and Adolescent Well-Being, this study examined out-of-home care factors for 2215 urban American Indian/Alaskan Native (AI/AN) and White children. In the urban sample, children from White families were younger and were more likely to be investigated for lack of supervision, while AI/AN families were investigated for physical neglect. In the placement regression models, urban AI/AN children came from homes where caregivers had greater alcohol, drug and mental health problems. Decisions by CPS workers to place AI/AN children may have been influenced by racial bias. A CPS system that acknowledges culture and race may reduce overrepresentation in placement. Efforts to work with AI/AN families prior to a child's removal may prove to be beneficial and less expensive.

Copyright 2010, Elsevier Science

Cheng TC. Factors associated with reunification: A longitudinal analysis of long-term foster care. Children and Youth Services Review 32(10): 1311-1316, 2010. (45 refs.)

Longitudinal analysis and a secondary sample of 411 children were used to examine how child welfare worker engagement with families and parent receipt of needed services shaped the outcomes for children in long-term foster care. The data came from the National Survey of Child and Adolescent Well-Being. Multinomial logistic regression showed reunification to be likeliest for neglected children who had caseworkers deeply involved with their families; whose families needed housing and financial assistance but not domestic violence services, specifically; and who were provided appropriately matched services. Adoption was likeliest for neglected children who had caseworkers deeply involved with their families; whose families needed substance-abuse services but not housing services; whose families had a high risk of re-reporting; whose parents were married; who were White and relatively young; and who had experienced foster care for relatively longer periods. Implications for services and training are discussed.

Copyright 2010, Elsevier Science

Coleman-Cowger VH; Green BA; Clark TT. The impact of mental health issues, substance use, and exposure to victimization on pregnancy rates among a sample of youth with past-year foster care placement. Children and Youth Services Review 33(11): 2207-2212, 2011. (37 refs.)

The purpose of this study is to (1) compare youth entering substance abuse treatment with and without a history of foster care placement to determine any differences in mental health, substance use, and exposure to victimization, and (2) determine if mental health, substance use, and/or exposure to victimization predict past pregnancy among the sample with a history of foster care placement. The pooled dataset consisted of 17,124 adolescents (12-17 years of age) who completed the Global Appraisal of Individual Needs at intake for substance abuse treatment in 2009. Of these, 366 (2.1%) reported having been in foster care in the past year. When compared with a non-foster care sample, the foster care sample reported significantly higher internal mental distress scores, behavior complexity scores, and general victimization scores, after controlling for race, gender, and level of care. Problems associated with substance use did not differ between groups, though regular tobacco use was present at a higher rate in the foster care sample. Multivariate logistic regression results revealed that, within the foster care sample, internal mental distress and gender predicted past pregnancy. There may be room for intervention within substance abuse treatment centers for youth with a history of foster care, who may be at risk for pregnancy if their levels of internal mental distress are high.

Copyright 2011, Elsevier Science

Cowal K; Shinn M; Weitzman BC; Stojanovic D; Labay L. Mother-child separations among homeless and housed families receiving public assistance in New York City. American Journal of Community Psychology 30(5): 711-730, 2002. (51 refs.)

We examined the incidence, characteristics, and predictors of separations of children from mothers in 543 poor families receiving public assistance, 251 of whom had experienced homelessness during the previous 5 years. Forty-four percent of the homeless mothers and 8% of housed mothers were separated from one or more children. A total of 249 children were separated from 110 homeless families and 34 children from 23 housed families. Children were placed with relatives and in foster care but were rarely returned to their mothers. Maternal drug dependence, domestic violence, and institutionalization predicted separations, but homelessness was the most important predictor, equivalent in size to 1.9 other risk factors. We infer that policies regarding child welfare and substance abuse treatment should be changed to reduce unnecessary placements. Studies of homeless children who remain with families may be biased if separated children are excluded.

Copyright 2002, Plenum Press

d'Arlach L; Curtis CE; Ferrari JR; Olson BD; Jason LA. Substance-abusing women and their children: A cost-effective treatment option to incarceration. Journal of Social Work Practice in the Addictions 6(4): 71-90, 2006

Low-level drug offenses are presently the top reason women are sent to jail. Because more than 70% of these incarcerated women are the primary caretakers of children, incarceration has resulted in a sharp rise in foster care demand. Research suggests that incarcerated women who remain with their children are more likely to enter and complete treatment. This paper reviews the effects of incarceration and the available treatment options for substance-abusing women with children. A self-supported, self-run, alternative treatment model known as Oxford House is suggested as an option for women with children to gain financial and emotional stability.

Copyright 2006, Routledge

Doris JL; Meguid V; Thomas M; Blatt S; Eckenrode J. Prenatal cocaine exposure and child welfare outcomes. Child Maltreatment 11(4): 326-337, 2006. (41 refs.)

This study examines the relationship between prenatal cocaine exposure and child welfare outcomes. Seventy-six infants positive for cocaine at birth were matched to 76 negative infants. With prenatal care and maternal use of alcohol and tobacco controlled, cocaine-exposed infants had significant decrements in birth weight, length, head circumference, and depressed 5-min Apgar scores. This confirmed the health risk of prenatal cocaine exposure for the sample. Three-year follow-up data were obtained from the State Central Register and foster care records. Adjusting for prior maternal involvement with child welfare services the study groups did not differ in incidents of child maltreatment or foster care placement. These findings suggest that prenatal cocaine exposure is not a marker for abusive parenting. However, from the perspective of a cumulative risk model, the identification of cocaine-exposed infants at birth can form the starting point for the development of appropriate diagnostic and follow-up services for mother and child.

Copyright 2006, Sage Publications

Dregan A; Brown J; Armstrong D. Do adult emotional and behavioural outcomes vary as a function of diverse childhood experiences of the public care system? Psychological Medicine 41(10): 2213-2220, 2011. (28 refs.)

Background. Longitudinal data from the 1970 British Cohort Study were used to examine the long-term adult outcomes of those who, as children, were placed in public care. Method. Multivariate logistic estimation models were used to determine whether public care and placement patterns were associated with adult psychosocial outcomes. Seven emotional and behavioural outcomes measured at age 30 years were considered: depression, life dissatisfaction, self-efficacy, alcohol problems, smoking, drug abuse, and criminal convictions. Results. The analyses revealed a significant association between public care status and adult maladjustment on depression [odds ratio (OR) 1.74], life dissatisfaction (OR 1.45), low self-efficacy (OR 1.95), smoking (OR 1.70) and criminal convictions (OR 2.13). Conclusions. Overall, the present study findings suggest that there are enduring influences of a childhood admission to public care on emotional and behavioural adjustment from birth to adulthood. Some of the associations with childhood public care were relatively strong, particularly with respect to depression, self-efficacy and criminal convictions.

Copyright 2011, Cambridge University Press

Farruggia SP; Sorkin DH. 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, 2009. (56 refs.)

Little research to date has examined older foster care youths' physical health and the associated health behaviours of the youth and important people in their lives (parents, peers and important non-parental adults). Older US foster care youth (n = 188) completed surveys on multiple indicators of self-report physical health, including number of chronic health problems, overall health and sick symptoms, as well as their own health-compromising behaviours and the health-compromising behaviours of important others. The findings suggested that boys, particularly those placed in non-kin foster homes and group homes, appeared to have poorer health than did boys in these placement settings. Girls, however, engaged in similar levels of health-compromising behaviours as boys. Furthermore, the health-compromising behaviours of peers and important non-parental adults (VIPs), but not parents, were associated with youths' health behaviours, which, in turn, were associated with the physical health status of the foster care youth. Youth report high levels of health-related problems and involvement in health-compromising behaviours. Healthcare practitioners can help to improve the health and well-being of children in foster care by becoming informed about adolescent health behaviours, as well as the health behaviours of their peers and other important non-parental adults.

Copyright 2009, Wiley-Blackwell

Fernandez E; Lee JS. Returning children in care to their families: Factors associated with the speed of reunification. Child Indicators Research 4(4, special issue): 749-765, 2011. (58 refs.)

Various factors influence children's tenure in protective care. The current study examined whether the speed of reunification with parents differs by reasons in care and social environment at intake. The effects of age and sex of the child and referral source were also examined. The study sample consists of 155 children aged 0-12 years from 92 families, who presented at Barnardos temporary care services in two metropolitan areas in Australia. Participants continuously entered the study over the 4 year study period from 1 Jan 2003 to 31 Dec 2008, the study window being 18 months since the intake. Drawing on event history analysis models two analyses were conducted: one focusing on the primary reason in care and another focusing on a risk typology based on the North Carolina Family Assessment Scale-Reunification (NCFAS-R). The risk typology developed through latent profile analysis grouped families with similar profiles of social environmental risks together. Children were reunified with their parents rapidly at the beginning until week 13 and the rate became slower but steady until the end of study period. Compared to children with parental health issues, children with parental substance abuse issues had 86% lower rate, children who experienced abuse/neglect had 83% lower rate of return, children from domestic violence situations or other issues had 73% lower rate of reunification with their parents. Compared to children with low risks in their social environment, children with high risks had 73% lower speed of reunification with their parents. The rate of reunification with parents was higher for older children whereas there was no difference on the speed of reunification by child's sex or the source of referral. The implications for policy, practice, and research are discussed.

Copyright 2011, Springer

Frank DA; Jacobs RR; Beeghly M; Augustyn M; Bellinger D; Cabral H et al. Level of prenatal cocaine exposure and scores on the Bayley Scales of Infant Development: Modifying effects of caregiver, early intervention, and birth weight. Pediatrics 110(6): 1143-1152, 2002. (52 refs.)

Objectives. The objectives of this study were 1) to assess whether there is an independent association between the level of prenatal cocaine exposure and infants' developmental test scores after control of potential confounding variables; and 2) if such an association exists, to determine which biological and social variables, individually and in interaction with each other, may modify it. Methods. In a prospective, longitudinal study of 203 urban term infants, 3 cocaine exposure groups were defined by maternal report and infant meconium assay: unexposed, heavier cocaine exposure (>75th percentile self-reported days of use or meconium benzoylecognine concentration), or lighter cocaine exposure (all others). Examiners, masked to exposure history, tested infants at 6, 12, and 24 months of age with the Bayley Scales of Infant Development. Results. The final mixed linear regression model included as fixed covariates level of prenatal exposure to cocaine, alcohol, and cigarettes; prenatal marijuana exposure; gestational age and birth weight z score for gestational age; and gender. Age at test, caregiver at time of each test (biological mother, kinship caregiver, unrelated foster caregiver), and any previous child-focused early intervention were included as time-dependent covariates. There were no significant adverse main effects of level of cocaine exposure on Mental Development Index (MDI), Psychomotor Development Index (PDI), or Infant Behavior Record. Child-focused early intervention interacted with level of cocaine exposure such that heavily exposed children who received such intervention showed higher adjusted mean MDI scores than all other groups. Although the sample was born at or near term, there was also a significant interaction of cocaine exposure and gestational age on MDI scores, with those in the heavier exposure group born at slightly lower gestational age having higher mean MDI scores compared with other children born at that gestational age. There was also a significant interaction on MDI between child's age and caregiver. At 6 months, the adjusted MDI of children living with a kinship caregiver was 15.5 points lower than that of children living with their biological mother, but this effect was diminished and was no longer significant at 24 months (difference in means: 4.3 points). The adjusted mean MDI of children in unrelated foster care at 6 months was 8.2 points lower than children of biological mothers, whereas it was 7.3 points higher at 24 months. Early intervention attenuated the age-related decline in PDI scores for all groups. Birth weight <10th percentile was associated with lower PDI scores for children with heavier cocaine exposure and with lower MDI scores for all groups. Conclusions. Heavier prenatal cocaine exposure is not an independent risk factor for depressed scores on the Bayley Scales of Infant Development up to 24 months of age when term infants are compared with lighter exposed or unexposed infants of the same demographic background. Cocaine-exposed infants with birth weight below the 10th percentile for gestational age and gender and those placed with kinship caregivers are at increased risk for less optimal developmental outcomes. Pediatric clinicians should refer cocaine- exposed children to the child-focused developmental interventions available for all children at developmental risk.

Copyright 2002, American Academy of Pediatrics

Gilchrist G; Taylor A. Drug-using mothers: Factors associated with retaining care of their children. Drug and Alcohol Review 28(2): 175-185, 2009. (51 refs.)

Introduction and Aims. Research suggests that upwards of 50% of drug users do not live with their children, yet little is known about these children's living arrangements or the variables associated with mothers retaining care of their children. Design and Methods. This cross-sectional study examined the number of pregnancies and children born to female drug users receiving and not receiving treatment, the living arrangements of their children and the variables associated with not living with their children. Results. Data on 185 mothers from a study on psychiatric morbidity among drug users in Glasgow, Scotland were analysed. Participants had given birth to 327 children, 44% (132/297) of children were living with their mother; 26% (78/297) were being cared for by a family member and 20% (59/297) were in local authority care or had been adopted. 49% (87/179) of participants did not live with any of their children. Stepwise multiple forward logistic regression found that current depressive symptoms [odds ratios (OR) 3.90, 95% confidence intervals (CI) 1.78-8.55], lifetime involvement in prostitution (OR 3.12, 95% CI 1.41-6.93), lifetime history of homeless (OR 2.96, 95% CI 1.13-6.39), living with a drug user (OR 2.71, 95% CI 1.30-5.65) and ever being incarcerated (OR 2.47, 95% CI 1.17-5.21) were associated with participants not living with any of their children versus living with at least one of their children. Discussion and Conclusions. Access to drug treatment, mental health treatment and parent craft education should be enhanced for female drug users to assist them retain care of their children where possible.

Copyright 2009, Taylor & Francis

Grant T; Huggins J; Graham JC; Ernst C; Whitney N; Wilson D. Maternal substance abuse and disrupted parenting: Distinguishing mothers who keep their children from those who do not. Children and Youth Services Review 33(11): 2176-2185, 2011. (46 refs.)

Women with substance abuse disorders typically have psychosocial characteristics that put them at risk for disrupted parenting. Prior research indicates that comprehensive, accessible services tailored to the mothers' needs can contribute to family stability. This study further explores the complicated interplay of how maternal risk and protective characteristics and service elements are associated with reunification. The study contributes to existing literature by following mothers for three years; examining service needs as identified by the mother herself; using a summary proportion score to reflect the totality of services received to matched service needs identified; and using logistic regression to examine interactions of services received with critical maternal characteristics. The sample is comprised of 458 substance-abusing mothers enrolled during pregnancy or postpartum in the Washington State Parent-Child Assistance Program (PCAP), an evidence-based case management intervention. Participants' custody status was well distributed among four categories based on continuity of parenting. Findings indicate that at program exit 60% of the mothers were caring for their index child. These mothers had more treatment and mental health service needs met, had more time abstinent from alcohol and drugs, secure housing, higher income, and support for staying clean and sober. Among women with multiple psychiatric diagnoses, the odds of regaining custody were increased when they completed substance abuse treatment and also had a supportive partner. Mothers who lost and did not regain custody had more serious psychiatric problems and had fewer service needs met. We discuss implications of our findings for child welfare policy and practices.

Copyright 2011, Elsevier Science

Green BL; Rockhill A; Furrer C. Does substance abuse treatment make a difference for child welfare case outcomes? A statewide longitudinal analysis. Children and Youth Services Review 29(4): 460-473, 2007. (30 refs.)

Although substance abuse is one of the primary reasons that parents become involved with the child welfare system, there is surprisingly little empirical research that examines the relationship of substance abuse treatment to child welfare outcomes. In this statewide longitudinal study of 1911 women who had children placed in substitute care, we examined the influence of three key factors in the treatment process on child welfare outcomes. Results indicated that when these women entered treatment more quickly, spent more time in treatment, or completed at least one treatment episode, their children spent fewer days in foster care and were more likely to be reunified with their parents. These findings were significant even controlling for families' levels of risk including treatment and child welfare history, substance abuse frequency and chronicity, and demographic risks. Implications of these findings for improvements in the way that treatment services are provided to women in the child welfare system are discussed.

Copyright 2007, Elsevier Science

Gregoire KA; Schultz DJ. Substance-abusing child welfare parents: Treatment and child placement outcomes. Child Welfare 80(4): 433-452, 2001. (51 refs.)

The authors present findings from their study of 167 child welfare parents referred for substance abuse assessments. Relationships between gender, prior treatment, court-ordered intervention, significant others' support, and treatment and placement outcomes are examined. Findings indicate significant others' support positively influences all outcomes while court-ordered intervention is not predictive. Prior treatment is associated with continued substance abuse. Gender differences exist for assessment completion and several client characteristics. Implications for practice are drawn.

Copyright 2001, Child Welfare League of America

Grella CE; Greenwell L. Correlates of parental status and attitudes toward parenting among substance-abusing women offenders. Prison Journal 86(1): 89-113, 2006. (73 refs.)

This study examined the correlates of loss of parental rights and attitudes toward parenting among a sample of substance-abusing women offenders (N=483). One third of the sample had lost parental rights to a child; these mothers were younger, but had more children, were less likely to have ever worked or been married, initiated regular drug use at a younger age, and were more likely to have been in foster care or adopted themselves and to have engaged in sex work. Higher self-efficacy, decision making ability, social conformity, and childhood problems were associated with less risky parental attitudes, whereas depression, lower education, and non-White ethnicity were associated with greater risk. Services that address the psychosocial needs of women offenders may increase the likelihood of successful family reunification following incarceration.

Copyright 2006, Sage Publications, Inc.

Grella CE; Needell B; Shi YF; Hser YI. Do drug treatment services predict reunification outcomes of mothers and their children in child welfare? Journal of Substance Abuse Treatment 36(3): 278-293, 2009. (67 refs.)

The effect of mothers' participation in substance abuse treatment on reunification with their children who are in out-of-home care is an important policy issue. This article examines the predictors of child reunification among mothers who participated in a statewide treatment outcome study. Data were integrated from multiple sources to determine the contributions of characteristics of mothers (n = 1, 115), their children (n = 2,299), and treatment programs (n = 43) on reunification outcomes. Hierarchical linear modeling was used to determine the fixed and random effects of mother, child, and program characteristics. Mothers with more employment and psychiatric problems were less likely to be reunified with their children; completion of 90 or more days in treatment approximately doubled their likelihood of reunification. Mothers who were treated in programs providing a "high" level of family-related or education/employment services were approximately twice as likely to reunify with their children as those who were treated in programs with "low" levels of these services.

Copyright 2009, Elsevier Science

Haight W; Ostler T; Black J; Sheridan K; Kingery L. A child's-eye view of parent methamphetamine abuse: Implications for helping foster families to succeed. Children and Youth Services Review 29(1): 1-15, 2007. (28 refs.)

This report focuses on the experiences and perspectives of rural, Midwestern children aged 7-14 years who were involved with the public child welfare system because of their parents' methamphetamine abuse. Eighteen children participated in semi-structured, in-depth interviews focusing on their families of origin. Children reported exposure not only to their parents' and non-kin adults' methamphetamine and other substance abuse, but to a constellation of activities related to drug use or drug seeking behavior including violence within their homes and other criminal behavior. Children responded to the contexts in which they were reared in a variety of ways including accepting or actively resisting socialization messages that normalized substance abuse. The majority of children described involvement with law enforcement and child welfare as a "sad" and "scary" time in their families. Far from embracing their placement within safe and stable families, many children continued to express sadness, distress and resistance to legal and child welfare interventions even after months in foster care. Implications for facilitating the adjustment of children to foster care and beyond are discussed including providing foster parents with support and information about the contexts in which children have been reared and children's understanding of those contexts in order that they may interpret and respond to challenges that may emerge.

Copyright 2007, Elsevier Science

Havnen KS; Breivik K; Stormark KM; Jakobsen R. Why do children placed out-of-home because of parental substance abuse have less mental health problems than children placed for other reasons? Children and Youth Services Review 33(10): 2010-2017, 2011. (51 refs.)

The purpose of this paper was to compare children placed out-of-home because of parental substance abuse (PSA) with children placed for other reasons (NPSA), and to explore the association between PSA and mental health problems in a Norwegian sample of 6- to 12-year-old children in out-of-home care (N=109). Several group differences were found related to the children themselves, their families and the Child Welfare case. The PSA children had less total difficulties, conduct problems and emotional problems than the NPSA children assessed by the teachers on the Revised Rutter Scale. However, both groups had far more mental health problems than children in general. The most important variable explaining the group difference in all subgroups of mental health problems was the extent of prosocial behavior in the children, but being placed for behavioral problems also explained a significant part of total difficulties and conduct problems. Variables like gender, discipline problems and socioeconomic conditions did not have a significant effect. The conclusion of the study was that prosocial behavior might be regarded as an important protective factor against mental health problems, which is an argument for investing in programs focusing on enhancing the placed children's mastering strategies.

Copyright 2011, Elsevier Science

Hjerkinn B; Lindbaek M; Skogmo I; Rosvold EO. Neuropsychological screening of children of substance-abusing women attending a Special Child Welfare Clinic in Norway. Substance Abuse Treatment, Prevention and Policy 5: e-journal, 2010. (45 refs.)

Background: Exposure to alcohol and illicit substances during pregnancy can have an impact on the child for the rest of his/her life. A Special Child Welfare Clinic (SCWC) in Norway provides care for pregnant women with substance abuse problems. Treatment and support are provided without replacement therapy. Methods: We performed a neuropsychological screening of 40 children aged four to 11 years whose mothers had attended the SCWC during pregnancy, and of a comparison group of 80 children of women without substance abuse problems. The children were presented with tests chosen from Wechsler Intelligence Scale for Children, third version (WISC-III), Nepsy, Halstead-Reitan and Raven's Progressive Matrices, Coloured Version. The tests were grouped into five main domains; (1) learning and memory, (2) visual scanning, planning and attention, (3) executive function, (4) visuo-motor speed and dexterity and (5) general intellectual ability. Results: No children in the study had test results in the clinical range in any domain. Bivariate analyses revealed that children of short-term substance-abusing mothers (who stopped substance abuse within the first trimester) had significantly lower test scores than the comparison group in three out of five domains (domain 2,3,4). Children of long-term substance abusers (who maintained moderate substance abuse throughout pregnancy) had significantly lower test results than the comparison group in one domain of the test results (domain 1). All but one child in the long-term group were or had been in foster homes. Most children in the short-term group stayed with their mothers. Multivariate regression analyses revealed that foster care minimum 50% of life time was associated with better scores on domains (1) learning and memory, (2) visual scanning, planning and attention, and (3) executive functions, while no significant associations with test scores was found for substance abuse and birth before 38 weeks of gestation. Conclusion: Children raised by former substance abusing mothers scored worse on the neuropsychological screening than children who had substance abusing mothers and mostly were raised in foster homes. This indicates that it is important to focus on the environment in cases where help and support are provided to presently or formerly addicted women raising children.

Copyright 2010, BioMed Central Ltd.

Hohman MM; Butt RL. How soon is too soon? Addiction recovery and family reunification. Child Welfare 80(1): 53-67, 2001. (19 refs.)

In order to assist child welfare workers involved in decision making regarding family reunification, this study examines the addiction recovery process and its impact on parenting behaviors. Two case examples applying this knowledge are presented, along with a discussion of their application to practice. In the model of alcoholism recovery, four stages of recovery are described: drinking, transition, early recovery, and ongoing recovery. Some of the risks for relapse are discussed. In a model of cocaine recovery, the stages leading to recovery described are withdrawal, the honeymoon stage (feeling optimistic), the wall (a depressive, discouraged, irritable phase), adjustment (a slow sense of recovery), and resolution (determined lifestyle changes). Although few studies have specifically investigated the recovery process on women, it has been suggested that low-income women in particular are prone to difficulty with recovery from substance addiction, as compared to their male counterparts. Two case studies illustrate these stages of recovery, and how these relate to recovery, particularly is bringing back together families affected by addiction. Social workers must have a working base knowledge of substance abuse and the dynamics involved in recovery. Applying the techniques outlined here will be a good indicator of how far along clients are in recovery. This can aid social workers in determining when clients are actively participating in their program, are active in treatment, and hopefully, are better able to parent their children.

Copyright 2001, Child Welfare League of America

Jones L. The first three years after foster care: A longitudinal look at the adaptation of 16 youth to emerging adulthood. Children and Youth Services Review 33(10): 1919-1929, 2011. (34 refs.)

Sixteen former foster youth were followed for 3 years to examine their adaptation to emerging adulthood. Youth were classified on their adaptation according to 2 concepts, Connectedness and Risks. Connectedness refers to engagement with the adult world through work, schooling, marriage, and parenthood. Risks refer to problems with substance abuse, financial difficulties, and mental health problems that would hinder engagement with the adult world. All of the youth maintained at least one adult connection, but only 6 youth did not have a risk at the final interview. Three years after discharge 50% of the respondents had a drug and/or alcohol problem, and had neither savings nor health insurance. Despite many problems the post foster care period was marked by much resilience as most struggled to remain independent, and continue their schooling. Factors which facilitated successful adaptations were: a period of transitional residence after foster care, good support systems including family and former social workers, and a commitment to further education.

Copyright 2011, Elsevier Science

Karoll BR; Poertner J. Judges', caseworkers', and substance abuse counselors' indicators of family reunification with substance-affected parents. Child Welfare 81(2): 249-269, 2001. (38 refs.)

The decision to reunify children with their substance-affected parent is highly complex and requires a tremendous amount of work and change on the part of the affected parent. This exploratory study identified indicators for safe reunification of children placed in foster care due to parental substance abuse, judges who hear juvenile cases, private agency child welfare caseworkers, and substance abuse counselors from a large midwestern state were surveyed using an instrument composed of a preliminary list of indicators identified through focus groups with these professional groups. Responses from 196 professionals who rated the importance of each item and subsequent factor analysis resulted in identification of 97 indicators. These indicators were grouped into the categories of motivation, recovery, competency; and rehability; social support; parenting skills; and legal issues. Implications of the findings for practice are discussed.

Copyright 2001, Child Welfare League of America

Keller TE; Blakeslee JE; Lemon SC; Courtney ME. Subpopulations of older foster youths with differential risk of diagnosis for alcohol abuse or dependence. Journal of Studies on Alcohol and Drugs 71(6): 819-830, 2010. (70 refs.)

Objective: Distinctive combinations of factors are likely to be associated with serious alcohol problems among adolescents about to emancipate from the foster care system and face the difficult transition to independent adulthood. This study identifies particular subpopulations of older foster youths that differ markedly in the probability of a lifetime diagnosis for alcohol abuse or dependence. Method: Classification and regression tree (CART) analysis was applied to a large, representative sample (N = 732) of individuals, 17 years of age or older, placed in the child welfare system for more than I year. CART evaluated two exploratory sets of variables for optimal splits into groups distinguished from each other on the criterion of lifetime alcohol-use disorder diagnosis. Results: Each classification tree yielded four terminal groups with different rates of lifetime alcohol-use disorder diagnosis. Notable groups in the first tree included one characterized by high levels of both delinquency and violence exposure (53% diagnosed) and another that featured lower delinquency but an independent-living placement (21% diagnosed). Notable groups in the second tree included African American adolescents (only 8% diagnosed), White adolescents not close to caregivers (40% diagnosed), and White adolescents closer to caregivers but with a history of psychological abuse (36% diagnosed). Conclusions: Analyses incorporating variables that could be comorbid with or symptomatic of alcohol problems, such as delinquency, yielded classifications potentially useful for assessment and service planning. Analyses without such variables identified other factors, such as quality of caregiving relationships and maltreatment, associated with serious alcohol problems, suggesting opportunities for prevention or intervention.

Copyright 2010, Alcohol Research Documentation Center

Kovalesky A. Factors affecting mother-child visiting identified by women with histories of substance abuse and child custody loss. Child Welfare 80(6): 749-768, 2001. (32 refs.)

The influence of maternal substance abuse upon the placement of children in out-of-home care increased significantly in the 1980s and 1990s, affecting mother-child visiting in numerous ways. Content analysis of interview data from 15 mothers with histories of illegal drug use and child custody loss provides insight into five major factors that can promote or inhibit visiting: (1) mother's drug use and health status, (2) effects of visits on the child, (3) transportation, (4) scheduling/visit settings, and (5) support of others.

Copyright 2001, Child Welfare League of America

Krauss RB; Thurman SK; Brodsky N; Betancourt L; Giannetta J; Hurt H. Caregiver interaction behavior with prenatally cocaine-exposed and nonexposed preschoolers. Journal of Early Intervention 23(1): 62-73, 2000. (52 refs.)

This study examined the quality of caregiver-child interaction as measured by the Parent/Caregiver Involvement Scale (PCIS) with a sample of 41 preschoolers who were prenatally exposed to cocaine and 39 nonexposed preschoolers. Within the cocaine group, 19 children were in the care of relatives or foster caregivers and 22 were in the care of their biological mothers. Results suggest that mothers of nonexposed children were significantly more emotionally and developmentally appropriate than caregivers of prenatally cocaine-exposed children, and no significant differences in interaction behavior were found between biological mothers and foster caregivers of prenatally cocaine-exposed children. The importance of conceptualizing this population of children within the context of their environment is stressed.

Copyright 2000, Council for Exceptional Children

Lenz-Rashid S. Employment experiences of homeless young adults: Are they different for youth with a history of foster care? Children and Youth Services Review 28(3): 235-259, 2006. (72 refs.)

There are approximately 350,000 young people between the ages of 18 and 24 who are homeless each year in the United States and some were placed in foster care as a minor. The purpose of this study is to examine the baseline information and outcomes following an employment training program for homeless transitional youth. A comparison is made between those with a history of foster care (FC) and those without (NFC). At baseline, the FC had significantly more youth of African-American decent and significantly less Caucasian youth than the NFC. Additionally, the FC were significantly more likely to have mental health issues and current substance abuse issues than the NFC. Approximately 60% of participants from each group found employment within 3 months following the training and the mean hourly wage of all participants post-training was $9.27 ($9.55 NFC and $8.88 FC). Follow-up comparisons found that having a mental health issue most significantly predicted whether a youth found employment following the employment training program, even while taking into consideration foster care history and all other control variables. Hispanic FC youth had significantly higher hourly wages after controlling for all other variables when compared to Hispanic NFC youth.

Copyright 2006, Elsevier Science

Leslie LK; Kelleher KJ; Burns BJ; Landsverk J; Rolls JA. Foster care and Medicaid managed care. Child Welfare 82(3): 367-392, 2003. (69 refs.)

Children in the foster care system are often dependent on Medicaid for health care. These children, however, have more complex health care needs than the typical child receiving Medicaid. States are implementing Medicaid managed care programs as a way to control escalating costs while providing necessary services. This article reviews the issues surrounding delivery of managed health care services to children in foster care and describes several solutions.

Copyright 2003, Child Welfare League of America

Lewis MW. Relationship of prior custody loss to maternal-fetal bonding in a subsequent pregnancy. Children and Youth Services Review 28(10): 1169-1180, 2006. (48 refs.)

Maternal-fetal bonding is the emotional investment a woman has for her fetus and is the foundation for nurturance and protection. Effects of prior custody loss on bonding during a subsequent pregnancy have received scant attention but may resemble other reproductive losses. This study compares the strength of the maternal-fetal bond among women grouped according to lifetime history of custody loss. Sixty-seven pregnant women with a history of giving birth were assigned to either a Loss (13.4%) or Non-Loss (86.6%) group. They were administered a demographic questionnaire and standardized measures of maternal-fetal bonding, substance use, perceived social support, depressive symptoms, and economic status. The Loss group endorsed more pregnancies, more abortions, living with fewer children, less social support, and illicit drug use during the third trimester. The Loss group endorsed a stronger maternal-fetal bond compared to women in Non-Loss group. Multivariate analyses were exploratory due to the small sample size but suggest that pregnant women who have experienced one custody loss may differ from those who have experienced multiple custody losses. Future research with a larger sample is needed to examine the direction of the relationship between prior custody loss and maternal bonding to a subsequent fetus.

Copyright 2006, Elsevier Science

Linares TJ; Singer LT; Kirchner HL; Short EJ; Min MO; Hussey P et al. Mental health outcomes of cocaine-exposed children at 6 years of age. Journal of Pediatric Psychology 31(1): 85-97, 2006. (59 refs.)

OBJECTIVE: To assess 6-year-old cocaine- and noncocaine-exposed children's mental health outcomes controlling for potential confounders. METHODS: The sample consisted of 322 children [169 cocaine exposed (CE) and 153 noncocaine exposed (NCE)] enrolled in a longitudinal study since birth. At age 6, children were assessed for mental health symptoms using the Dominic Interactive (DI), a child self-report measure, and the Child Behavior Checklist (CBCL), a caregiver report of behavioral problems. RESULTS: CE children were more likely to self-report symptoms in the probable clinical range for oppositional defiant disorder (ODD) and attention deficit hyperactivity disorder (ADHD). In contrast, prenatal cocaine exposure was not related to child behavior based on the CBCL. After control for exposure, CE children in adoptive or foster care were rated as having more problems with aggression, externalizing behaviors, and total behavioral problems than NCE children and CE children in maternal or relative care. Also, CE children in adoptive or foster care self-reported more externalizing symptoms than CE children in maternal or relative care and NCE children. Findings could not be attributed to caregiver intelligence or depressive symptoms, or to the quality of the home environment. CONCLUSIONS: CE children report more symptoms of ODD and ADHD than nonexposed children. Adoptive or foster caregivers rated their CE children as having more behavioral problems than did maternal or relative caregivers of CE children or parents of NCE children. Although further studies are needed to understand the basis for the more negative ratings by adoptive or foster caregivers of their CE children, the self-report of CE children indicates a need for psychological interventions.

Copyright 2006, Oxford University Press

Littell JH; Girvin H. Correlates of problem recognition and intentions to change among caregivers of abused and neglected children. Child Abuse & Neglect 30(12): 1381-1399, 2006. (52 refs.)

Objective: To identify individual, family, and caseworker characteristics associated with problem recognition and intentions to change in a sample of caregivers who received in-home child welfare services following substantiated reports of child abuse or neglect. Methods: Caregivers were interviewed at 4 weeks, 16 weeks, and 1 year after referral for in-home services. In these interviews, the University of Rhode Island Change Assessment scale assessed problem recognition and ITC in relation to caregiving practices. Additional data were obtained from administrative records and surveys of in-home services caseworkers. We used growth models to identify caregiver, family, and caseworker characteristics associated with initial levels of problem recognition and intentions to change, and with changes in problem recognition and intentions to change over time. Results: Contrary to expectations, there were no overall increases in problem recognition and intentions to change during the first 4 months of in-home services. Problem recognition and intentions to change scores fluctuated over time, in relation to some external events, case characteristics, and caseworker characteristics; however, we were able to account for small portions of the variance in problem recognition and intentions to change. Controlling for social desirability bias and other variables in the analysis, negative life events, lack of network support, and the severity of caregiver depression were associated with greater PR; housing problems were associated with lower problem recognition. Caregiver depression and age were associated withintentions to change. Caregivers whose children had been removed from their homes showed significant increases in intentions to change in the first few months of in-home services. The duration of caseworkers' child welfare experience predicted increases in their clients' problem recognition in the first 4 months and more frequent contacts with an experienced caseworker predicted small, but significant increases in intentions to change over time. Conclusions: Problem recognition and intentions to change are associated with somewhat different case characteristics and may be affected by caseworkers' experience.

Copyright 2006, Elsevier Science

Maluccio AN; Ainsworth F. Drug use by parents: A challenge for family reunification practice. Children and Youth Services Review 25(7): 511-533, 2003. (56 refs.)

Family reunification practice has been a cornerstone of child welfare services for the last decade or more. This practice is now challenged by a significant rise in the number of children entering out-of-home care due to abuse and neglect associated with parental drug use. These parents present a special problem for agencies in relation to reunification. Is it possible to ensure a child's safety and future development if reunification is pursued where parental drug use is ongoing? This article does three things. First, it cites the evidence about the incidence of drug use by parents of children in care. Second, it reviews the recent family reunification research and in so doing confirms the importance of family reunification efforts. Third, it proposes a three-stage model of enhanced reunification practice for use with parents to test the viability of reunification in situations where drug use remains an issue.

Copyright 2003, Pergamon Press Ltd.

Marshall MF; Menikoff J; Paltrow LM. Perinatal substance abuse and human subjects research: Are privacy protections adequate? (review). Mental Retardation and Developmental Disabilities Research Reviews 9(1): 54-59, 2003. (9 refs.)

Privacy incursions in the clinical care of substance abusing pregnant women have gained lay and professional attention recently as the result of a high-profile Supreme Court finding in Ferguson vs City of Charleston et al. In March, 2001 the Supreme Court determined that nonconsensual drug screening of pregnant women by clinicians in a public hospital violated the women's Fourth Amendment rights to be secure against unreasonable search and seizure. Coercive or punitive policy approaches to perinatal substance abuse are often based on mistaken assumptions about the nature of addiction and the outcomes of punitive interventions. Much attention has been given to efforts to criminalize pregnancy for drug using women, and civil laws are also coming under increasing scrutiny. Although no state has passed a law criminalizing pregnancy and drug use, an estimated 250 women in more than 30 states have been prosecuted around the country on theories of "fetal abuse." A growing number of states (eighteen to date) have amended their civil child welfare laws to address specifically the subject of a woman's drug use during pregnancy. No one has examined how these laws and social policies could affect research that includes pregnant and parenting women; women (and their families) who stand to lose a great deal should their drug use be brought to the attention of child welfare or criminal justice authorities. We examine the adequacy of current protective mechanisms, such as federal certificates of confidentiality, in protecting research subjects (and investigators) who may be subject to punitive civil or criminal sanctions. We determine that current protective mechanisms may be insufficient to protect research subjects and that investigators and IRB members are often ignorant of the risks imposed by punitive policy approaches to perinatal substance abuse or fall prey to the same mistaken assumptions that inform punitive policies. We conclude that investigators and IRB members have a moral responsibility to understand local, state and national policies and laws governing perinatal substance abuse. Investigators and IRB members should balance the harms of punitive interventions against the protections that may, or may not be afforded to prospective research subjects as well as the prospective benefits, individual and social, of the research. In situations where criminal or punitive policies are in effect, investigators and IRB members should consider whether adequate protections can be achieved. In the context of inadequate protections, potential risks to prospective research subjects and their families may outweigh the individual or. social benefits that accrue from the research. Clinical researchers are professionally obligated to work toward amending laws and policies that 4, are not in. the best interests of prospective research subjects.

Copyright 2003, Wiley-Liss, Inc.

McGlade A; Ware R; Crawford M. Child protection outcomes for infants of substance-using mothers: A matched-cohort study. Pediatrics 124(1): 285-293, 2009. (31 refs.)

OBJECTIVE: Parental drug use is a critical public health issue; it is estimated to be present in up to 80% of referrals to Australian child protection agencies. However, no data regarding the child protection outcomes of infants of substance-using parents exist in Australia, and no comparisons have been made with infants of non-substance-using parents. We assessed differences in substantiated abuse between 2 groups of mothers in Brisbane to quantify this risk. METHODS: Mothers who disclosed opiate, amphetamine, or methadone use between 2000 and 2003 were identified and compared with non-substance-using mothers who were matched for gender and gestational age. All infants were linked to the Department of Child Safety Child Protection Information System database. Child protection outcomes, such as substantiated notifications and entry into foster care, were compared between groups. RESULTS: We studied 119 infants of substance-using mothers and 238 matched infants. Infants of substance-using mothers were more likely to suffer substantiated harm (hazard ratio 13.3 [95% confidence interval 4.6-38.3]) and to enter foster care (hazard ratio 13.3 [95% confidence interval 5.1-34.3]). Infants of mothers using illicit drugs were more likely to suffer substantiated harm and more likely to enter foster care than infants of mothers who were compliant with a methadone program. CONCLUSIONS: Infants of substance-using mothers have much poorer child protection outcomes than infants of non-substance-using mothers. This study adds substantial evidence toward a real association between maternal drug use and child abuse. Greater interagency collaboration is urgently required to reduce this risk.

Copyright 2009, American Academy of Pediatrics

McNichol T; Tash C. Parental substance abuse and the development of children in family foster care. Child Welfare 80(2): 239-256, 2001. (15 refs.)

To determine the impact of parental substance abuse on children, the cognitive skills and behavior ratings of 268 school-age children placed in family foster care were examined. As a group, the children in family foster care presented with low average cognitive skills and made significant improvement in cognitive functioning during placement. The children with prenatal exposure to drugs scored significantly lower in cognitive skills at the beginning of placement but made significantly more progress than the other children during placement. Behavior ratings by the foster parents and teachers revealed that 29% of the children had scores in the significant range, and the children exposed prenatally to drugs had a higher incidence of behavior problems at school compared to family foster care peers. Recommendations for further study of these factors and for enhancing outcomes for children in care are provided.

Copyright 2001, Child Welfare League of America

Meyer AS; Mcwey LM; McKendrick W; Henderson TL. Substance using parents, foster care, and termination of parental rights: The importance of risk factors for legal outcomes. Children and Youth Services Review 32(5): 639-649, 2010. (80 refs.)

Using mixed methods, we compared appellate court foster care cases where parents' rights were terminated to those in which decisions to terminate parental rights were reversed or remanded to better understand the experiences of parents struggling with alcohol and drug use. A content analysis of 60 cases was conducted, 30 cases in which parental rights were terminated, and 30 where decisions to terminate parental rights were overturned or remanded to the lower court. Parents whose rights were terminated were more likely to have mental health problems and experienced incarceration. In addition, when a composite score of risk factors was analyzed, parents whose rights were terminated had significantly more risk factors. For both groups, poverty was an equally common risk factor. Implications include universal assessments for alcohol and drug abuse for parents involved in the child welfare system and timely refeirals to appropriate treatment. Further, collaboration between mental health providers, substance use treatment programs, and caseworkers to address the integration of potential risk factors may help promote successful outcomes for parents whose children are in foster care.

Copyright 2010, Elsevier Science

Miller KA; Fisher PA; Fetrow B; Jordan K. Trouble on the journey home: Reunification failures in foster care. Children and Youth Services Review 28(3): 260-274, 2006. (26 refs.)

We examined postreunification variables regarding parent characteristics, child characteristics, parent service utilization, child service utilization, family environment, and neighborhood environment as they relate to reunification failure. The sample for the study included foster children who, at reunification with their birth parents, ranged in age from 4-7 years. All participants were reunified with at least one parent. Among the variables found to significantly differentiate between failed and successful reunifications were parental utilization of substance abuse treatment, child utilization of special educational services, child utilization of individual, family, or group therapy, overall parenting skill level, appropriate use of discipline, and quality of neighborhood. We discuss the implications of these results for policies aimed at increasing the success rate of reunifications following foster care.

Copyright 2006, Elsevier Science

Moe V. Foster-placed and adopted children exposed in utero to opiates and other substances: Prediction and outcome at four and a half years. Journal of Developmental and Behavioral Pediatrics 23(5): 330-339, 2002. (54 refs.)

This article presents a Norwegian prospective, longitudinal study of children prenatally exposed to opiates and other substances under conditions of minimal postnatal social risk. Outcome at 4 1/2 years of age is presented. The study reports on the prediction of later intellectual performance, on the basis of the children's prenatal, perinatal, and early developmental status, as well as the foster or adoptive parents' socioeconomic level. Significant differences were found between the substance-exposed group and the comparison group on the Bayley Scales at age 1 year and on the McCarthy Scales at age 4 1/2 years. The findings showed that although the mean cognitive scores were within normal limits at age 4 1/2 years, a special weakness in the area of visual-motor and perceptual abilities was detected among the substance-exposed children. It is indicated that these areas of performance are especially sensitive to the effect of prenatal adversity. A special vulnerability among the substance- exposed boys, detected at an earlier age, persisted at 4 1/2 years. The study indicates that even if children experience adequate caregiving, the accumulation of biomedical risk factors associated with prenatal substance exposure is still a potential determinant of developmental problems, especially in the area of perceptual-performance functions. The study also hints at differential influences of biomedical and environmental variables on outcome at age 4 1/2 years.

Copyright 2002, Lippincott, Williams & Wilkens

Morehouse E; Tobler NS. Preventing and reducing substance use among institutionalized adolescents. Adolescence 35(137): 1-28, 2000. (36 refs.)

The Residential Student Assistance Program, serving high-risk, multiproblem, inner-city, primarily African-American and Latino youth, was evaluated for its ability to prevent and decrease alcohol and other drug use. Participants were drawn from several adolescent residential facilities: three foster care sites for abused, neglected, orphaned, or troubled adolescents, a nonsecure facility for adjudicated juvenile offenders, a treatment center for teens with severe psychiatric problems, and a locked county correctional facility. In addition, comparison groups were employed. A 5th-year outcome evaluation documented the program's effectiveness in both preventing and reducing substance use among participants, with impact related to program dosage. Qualitative process data clarified and strengthened confidence in the quantitative outcomes.

Copyright 2000, Libra Publishers. Used with permission

Narendorf SC; McMillen JC. Substance use and substance use disorders as foster youth transition to adulthood. Children and Youth Services Review 32(1): 113-119, 2010. (30 refs.)

Little research has previously examined substance use and substance use disorders as youth age out of foster care. This study examined rates of getting drunk, marijuana use, and substance use disorders over time for a cohort of 325 older youth in foster care in Missouri. Rates of past month marijuana use increased from 9% at age 17 to 20% at age 19. Rates of getting drunk in past year increased from 18% at age 18 to 31% at age 19. Compared to the general population, older foster youth had lower rates of substance use but higher rates of substance use disorders (SUD), with 15% of youth meeting criteria for a SUD at age 19. Youth who had left the custody of the state had significantly higher rates of alcohol and marijuana use at ages 18 and 19. Transitions out of residential care and into independent living situations were associated with use of substances at age 18. Different risk factors were associated with substance use at ages 18 and age 19 while risk factors for SUDs were more stable over time. Findings highlight the need to screen and provide treatment for SUDs before youth leave state custody and to consider substance abuse treatment in decisions to extend care beyond age 18.

Copyright 2010, Elsevier Science

Olmstead SB; McWey LM; Henderson T. In the child's best interest: Terminating the rights of fathers with children in foster care. Journal of Family Issues 32(1): 31-54, 2011. (48 refs.)

The authors conducted a content analysis of appellate court foster care cases in which fathers appealed the termination of their parental rights. Applying the Responsible Fathering framework to organize the contextual issues that impede men from responsibly fathering, the authors sought to learn what factors affect decisions regarding the termination of their parental rights. Multiple risk factors emerged including lack of social support, financial resources, and opportunities. Implications for practitioners include attending to father's mental health, alcohol and/or substance abuse, issues surrounding incarceration, and the coparental relationship.

Copyright 2011, Sage Publications

Ondersma SJ; Malcoe LH; Simpson SM. Child protective services' response to prenatal drug exposure: Results from a nationwide survey. Child Abuse & Neglect 25(5): 657-668, 2001. (12 refs.)

OBJECTIVE: This survey was conducted to: (1) document child protective services (CPS) agencies' actual practices regarding prenatal drug exposure; (2) examine urban and rural differences in CPS responses; (3) explore whether CPS practices varied as a function of county median income, birth rate, population size, or percent minority births; and (4) assess respondent satisfaction with their county's current responses. METHOD: Data were collected via a nationwide telephone survey of child welfare supervisors from two urban and two rural counties in every state (N = 200). RESULTS: Ninety percent of counties (100% of urban and 80% of rural) reported receiving referrals of infants with prenatal drug exposure. Among those receiving referrals, extreme variations in practice were found; all possible response options (from very inactive to very aggressive) were equally represented on key questions (e.g., filing court petitions, taking custody). Rural counties tended to have stronger responses than urban counties (t[175] = -2.26, p = .024). County response did not vary with county-level median family income, percent minority births, or birth rate. Despite wide variations in practice, the majority of respondents (69%) felt their county's response was appropriate. Of respondents who did indicate that their county's response was inappropriate, most (85%) felt that the county needed to do more to protect children. CONCLUSIONS: There is currently tremendous variation across US counties in CPS responses to, and beliefs regarding, the issue of prenatal drug exposure. Some of this variation is due to differences between urban and rural counties, with little variation explained by differences in median income or percent minority births at the county level. There is a need for research-based guidance and consensus building in CPS practice in this area.

Copyright 2001, Elsevier Science Ltd

Pecora PJ. Why current and former recipients of foster care need high quality mental health services. Administration and Policy in Mental Health and Mental Health Services Research 37(1-2, special issue): 185-190, 2010. (36 refs.)

This commentary presents data about the emotional, behavioral, and substance abuse disorders of youth in foster care and former recipients of foster care ("alumni") in the United States to underscore the reasons why high quality mental health services are essential.

Copyright 2010, Springer

Pecora PJ; White CR; Jackson LJ; Wiggins T. Mental health of current and former recipients of foster care: A review of recent studies in the USA. Child & Family Social Work 14(2, Special Issue): 132-146, 2009. (76 refs.)

This paper presents data about the emotional, behavioural and substance abuse disorders of youth in foster care and former recipients of foster care ('alumni') in the. The prevalence rates of these groups are compared to those of the youth and young adults in the US general population. The implications of these data for policy and program design are discussed.

Copyright 2009, Wiley-Blackwell

Petras DD; Massat CR; Essex EL. Overcoming hopelessness and social isolation: The ENGAGE model for working with neglecting families toward permanence. Child Welfare 81(2): 225-248, 2001. (48 refs.)

The Adoption and Safe Families Act of 1997 (ASFA) mandates policies designed to increase the frequency and speed with which permanency is achieved for children in the child welfare system. ASFA's focus is on child safety permanency, and well-being. The expectation that parents correct neglectful conditions within specified time frames places an increased ethical responsibility on child welfare staff. Carrying out this responsibility requires vigorous and innovative approaches to engaging and working with neglectful families. Drawing on a well- established conceptual framework for understanding the determinants of effective parenting, the authors derive the ENGAGE (Engagement, Needs assessment, Goal setting, Assessment of progress, Goal achievement, Ending work) model for achieving permanency within the policy structure. The model incorporates creative client engagement, assessment of family needs, mutual goal setting, the goal achievement process, termination, and aftercare.

Copyright 2001, Child Welfare League of America

Pilowsky DJ; Lyles CM; Cross SI; Celentano D; Nelson KE; Vlahov D. Characteristics of injection drug using parents who retain their children. Drug and Alcohol Dependence 61(2): 113-122, 2000. (12 refs.)

While it is known that injection drug users (IDUs) often have their children removed or place them voluntarily, little is known about factors associated with whether IDU parents live with their children. We identified a community sample of 391 IDU parents with at least one child under age 14 (index IDU parents). For these IDU parents, 62% did not have any of their children under age 14 living with them. We assessed whether certain health factors, risk related behaviors, social indicators, and active drug use were related to whether children of IDUs were living with the index IDU parent. IDU parents who were living with their children were overwhelmingly more likely to be female, more likely to have health insurance, and engage in no- risk or low-risk drug practices, as compared to moderate/high-risk practices. Additionally, HIV negative and HIV positive asymptomatic parents were about three times more likely to be living with their children than HIV positive parents with clinical symptoms commonly seen among those suffering from HIV-related illnesses. HIV-related clinical symptoms, rather than HIV status per se, seem to be associated with retention of children.

Copyright 2000, Elsevier Scientific Publishers Ireland, Ltd.

Pilowsky DJ; Wu LT. Psychiatric symptoms and substance use disorders in a nationally representative sample of American adolescents involved with foster care. Journal of Adolescent Health 38(4): 351-358, 2006. (40 refs.)

Purpose: To ascertain the prevalence of psychiatric symptoms and substance use disorders among adolescents with a lifetime history of foster care placement, using data from a nationally representative sample of U.S. adolescents. Methods: We studied adolescents aged 12-17 years in the public use file of the 2000 National Household on Drug Abuse (n = 19,430, including 464 adolescents with history of foster care placement). Psychiatric symptoms and substance use disorders were ascertained through direct interviewing of adolescents. Logistic regression analyses were used to estimate the odds of past-year psychiatric symptoms and substance use disorders among adolescents involved with foster care. as compared to those without a lifetime history of foster care placement (comparison croup). Results: Adolescents involved with foster care had more past-year psychiatric symptoms, and especially more conduct symptoms, and past-year substance use disorders than those never placed in foster care. Adolescents involved with foster care were about four times more likely to have attempted suicide in the preceding 12 months (adjusted odds ratio [AOR] 3.95; 95% confidence interval [CI] 2.78, 5.61), and about five times more likely to receive a drug dependence diagnosis in the same period (AOR 4.81; 95% CI 3.22, 7.18). Conclusions: Adolescents involved with foster care have a higher prevalence of psychiatric symptoms and drug use disorders than those never placed in foster care. Additionally, the results of this study suggest that they may be at elevated risk for suicide attempts.

Copyright 2006, Society for Adolescent Medicine

Sagatun-Edwards I; Saylor C. A coordinated approach to improving outcomes for substance-abusing families in juvenile dependency court. Juvenile & Family Court Journal 51(4): 1-16, 2000. (28 refs.)

This paper describes a coordinated approach to providing enhanced services for substance-abusing families in the juvenile dependency court, The enhanced services consisted of on interagency collaborative model including the Department of Social Services, Court Appointed Special Advocates, Public Health Nurses, and Family Support Specialists. The purpose of the intervention was to increase the likelihood of family reunification. Families were randomly assigned to either the enhanced services (N=48) or to a regular services group (N=41). Variables included social background factors, data related to court hearings and court orders, and final court outcomes regarding placement and custody Significant factors predicting final placement of the child were completion of court ordered programs, a stable home, and mothers' cooperation and motivation. Families who received the enhanced services had significantly higher rates of reunification of children with parents.

Copyright 2000, National Council of Juvenile Family Court Judges

Sarkola T; Gissler M; Kahila H; Autti-Ramo I; Halmesmaki E. Early healthcare utilization and welfare interventions among children of mothers with alcohol and substance abuse: A retrospective cohort study. Acta Paediatrica 100(10): 1379-1385, 2011. (23 refs.)

Aim: Early childhood healthcare utilization, mortality and welfare interventions were studied among children of mothers with identified gestational alcohol and/or substance abuse. Methods: Register-based retrospective cohort study. The exposed cohort consisted of 638 children born to 524 women followed up antenatally 1992-2001 at special outpatient clinics in the capital area of Finland. Nonexposed children (n = 1914) born to control women were matched for maternal age, parity, number of foetuses, month of birth and delivery hospital of the index child. Postnatal data of both cohorts were collected from national registers until 2007. Results: The exposed cohort displayed twice the amount of in- and outpatient hospital care episodes compared with nonexposed children. Differences attributable to exposure were found in categories of conditions originating in the perinatal period, mental and behavioural disorders, and nonspecific factors influencing health status and contact with health services. This was reflected in amounts of reimbursements for drugs of the central nervous system, as well as special care allowances and rehabilitation for mental and behavioural disorders. The highest degree of healthcare utilization was observed among exposed children placed in out-of-home care. One-third of these children received outpatient care and one-tenth required inpatient care for a mental and behavioural disorder. No significant differences were found in early mortality. Conclusion: The exposed children displayed significant neonatal and early mental and behavioural healthcare utilization, and need for significant psychosocial support during their first decade of life.

Copyright 2011, Wiley-Blackwell

Scott LD Jr; Munson MR; McMillen JC; Ollie MT (1). Religious involvement and its association to risk behaviors among older youth in foster care. American Journal of Community Psychology 38(3/4): 223-236, 2006. (61 refs.)

This study examined religious involvement and its association to risk behaviors (sexual behavior, marijuana use, alcohol use, and cigarette use) among older youth in foster care (N = 383). Three dimensions of religious involvement were assessed--church or religious service attendance, religious practices, and religious beliefs. Findings showed that gender, ethnic group membership, sexual abuse history, and placement type were significantly associated with older foster care youth's religious involvement. Hierarchical logistic regression analyses showed that religious service attendance was associated with reduced odds of youth's engagement in sexual behavior in the past 2 months and current use of cigarettes. In addition, greater religious beliefs were associated with a reduction in odds of youth's use of alcohol in the past 6 months and current use of cigarettes. The consideration of religious involvement as a positive influence and resource that may reduce unhealthy risk behaviors among older youth in foster care is discussed.

Copyright 2006, American Psychological Assocition

Scott LD; Munson MR; McMillen JC; Ollie MT. Religious involvement and its association to risk behaviors among older youth in foster care. American Journal of Community Psychology 38(3-4): 223-236, 2006. (61 refs.)

This study examined religious involvement and its association to risk behaviors (sexual behavior, marijuana use, alcohol use, and cigarette use) among older youth in foster care (N=383). Three dimensions of religious involvement were assessed-church or religious service attendance, religious practices, and religious beliefs. Findings showed that gender, ethnic group membership, sexual abuse history, and placement type were significantly associated with older foster care youth's religious involvement. Hierarchical logistic regression analyses showed that religious service attendance was associated with reduced odds of youth's engagement in sexual behavior in the past 2 months and current use of cigarettes. In addition, greater religious beliefs were associated with a reduction in odds of youth's use of alcohol in the past 6 months and current use of cigarettes. The consideration of religious involvement as a positive influence and resource that may reduce unhealthy risk behaviors among older youth in foster care is discussed.

2006, Springer

Scott-Lennox J; Rose R; Bohlig A; Lennox R. The impact of women's family status on completion of substance abuse treatment. Journal of Behavioral Health Services & Research 27(4): 366-379, 2000. (24 refs.)

This study examines the role of family status and demographic characteristics in explaining the nearly 60% dropout rate for women in substance abuse treatment. Data from the administrative record files of the Illinois Office of Alcoholism and Substance Abuse (OASA) for the fiscal rear 1996-97 were analyzed for women age 12 or older who completed intake for publicly funded substance abuse treatment and whose outpatient treatment records were closed at year-end. Multivariate logistic regression models found that the likelihood of not completing treatment was greatest for women who were African American pregnant, had custody of minor children, or were younger than age 21. However African American women who had children in foster care were more likely to complete treatment. Implications for treatment and research are discussed.

Copyright 2000, Sage Publications. Inc.

Seale JP; Shellenberger S; Spence J. Alcohol problems in Alaska Natives: Lessons from the Inuit. American Indian and Alaska Native Mental Health Research 13(1): 1-31, 2006. (75 refs.)

In this Alaska Native study, cultural "insiders" analyzed problems associated with increased alcohol availability, factors which have reduced alcohol-related problems, and ideas for improving treatment in an Inuit community. Participants described frequent bingeing, blackouts, family violence, suicide, loss of child custody, and feelings of intergenerational grief. Helpful existing treatment approaches include alcohol ordinances, inpatient treatment programs, twelve-step groups, and religious involvement. Participants urged the development of family treatment approaches which integrate Inuit customs and values.

Copyright 2006, University Press of Colorado

Simmel C; Brooks D; Barth RP; Hinshaw SP. Externalizing symptomatology among adoptive youth: Prevalence and preadoption risk factors. Journal of Abnormal Child Psychology 29(1): 57-69, 2001. (56 refs.)

The extent of symptomatology related to attention-deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) was examined in a statewide sample of adopted youth, aged 4-18 years (n = 808). The use of normed questionnaires in a nonclinical sample decreased biases associated with past research on adopted children. According to parental report, a striking number of the youth qualified as manifesting significant symptom levels of externalizing behavior problems: 21% met symptom cutoffs for ADHD (with or without ODD) and 20% met criteria for ODD (with or without ADHD), for a combined total of 29% of the sample. A number of parent-reported, preadoptive risk factors distinguished these groups from one another and from the nonexternalizing youth. The clearest associated factors included histories of preadoption abuse/neglect, later age of adoption, prenatal drug exposure, and placement in multiple foster homes prior to adoption. We discuss implications regarding both etiology and current controversies surrounding the disproportionate levels of behavioral difficulties in adopted youth.

Copyright 2001, Plenum Publishing Corporation

Slesnick N; Meade M. System youth: A subgroup of substance-abusing homeless adolescents. Journal of Substance Abuse 13(3): 367-384, 2001. (78 refs.)

Purpose: While many youths residing at homeless shelters will return home, many are placed in group or foster homes. Few researchers have examined the experiences of adolescents with a history of these out-of-home placements. This study examined shelter residents and compared the experiences of system and non-system youth. Methods: Information regarding youths' family functioning, substance use, depression and related problem behaviors was obtained from substance abusing system (n = 62) and non-system (n = 82) adolescents staying at local runaway shelters. Results: System males engaged in significantly more delinquent behaviors than did non-system males and system females. Alcohol and drug problem consequences were positively associated with longevity in the system, while having ever attempted suicide was negatively associated with system longevity. System youth reported: 1) taking more prescribed psychotropic medications 2) experiencing more sexual abuse, and 3) less parental overprotection, as compared to non-system youth. Gender differences were found in which females reported more conflictual problem solving interactions with their parents than did males, as well as more comorbid diagnoses. Implications: Although longitudinal research is needed, findings argue that without intervention efforts targeted at identified problem behaviors, youth are at risk to continue their system involvement into adulthood.

Copyright 2001, Ablex Publishing Corp.

Smith BD; Testa MF. The risk of subsequent maltreatment allegations in families with substance-exposed infants. Child Abuse & Neglect 26(1): 97-114, 2002. (22 refs.)

Objective: This study seeks to: (1) assess the relationship between identified prenatal substance use and the risk of subsequent maltreatment allegations among families involved with child protective services; and (2) compare the types of safety threats encountered by children whose parents had substance-exposed infant (SEI) allegations to the types of safety threats faced by children whose parents had other types of allegations. Method: Survey data from a probability sample of parents were linked to state administrative data over a 33-month time frame. Cox regression models were conducted to assess the relative risk of subsequent allegations associated with parents whose child welfare case opened following an SEI allegation (the SEI group) compared to parents whose case opened following other types of allegations. Results: The likelihood of subsequent allegations is greater among parents in the SEI group. However, the increased risk sterns almost entirely from subsequent SEI-related allegations. Parents in the SEI group are not more likely to incur other types of allegations such as physical abuse or lack of supervision. Conclusions: An increased risk of subsequent maltreatment has been used to justify opening child protective cases on the basis of an SEI allegation alone. By looking closely at the types of subsequent allegations as well as the incidence of subsequent allegations, this research helps to clarify the maltreatment risks associated with SEI cases.

Copyright 2002, Elsevier Science Ltd.

Smith DK; Chamberlain P; Eddy JM. Preliminary Support for Multidimensional Treatment Foster Care in Reducing Substance Use in Delinquent Boys. Journal of Child & Adolescent Substance Abuse 19(4): 343-358, 2010 , 2010. (60 refs.)

Although effective outpatient treatments have been identified for the well-documented negative outcomes associated with delinquency and substance use, effective treatments for youths in out-of-home care are rare. In this study, 12- and 18-month substance use outcomes were examined for a sample of 79 boys who were randomly assigned to Multidimensional Treatment Foster Care (experimental condition) or to group care (comparison condition). The boys in the experimental condition had lower levels of self-reported drug use at 12 months, and lower levels of tobacco, marijuana, and other drug use at 18 months. Limitations and future directions are discussed.

Copyright 2010, Haworth Press

Suchman NE; McMahon TJ; Zhang HP; Mayes LC; Luthar S. Substance-abusing mothers and disruptions in child custody: An attachment perspective. Journal of Substance Abuse Treatment 30(3): 197-204, 2006. (33 refs.)

Using an attachment framework, we examined (1) whether substance-abusing mothers' perceptions of how they were patented were related to the severity of their substance abuse and psychological maladjustment and (2) whether these two factors mediated the association between mothers' perceptions of how they were parented and their children's placement out of home. There were 108 mothers of 248 children who completed interviews upon admission to a methadone maintenance program for women. Measures included lifetime risk composite scores derived from the Addiction Severity Index, the Parental Bonding Instrument, and a demographics questionnaire. A multilevel modeling approach was used to model effects of the hierarchically organized data (e.g., children nested within families). Findings are consistent with an attachment perspective on parenting suggesting that the internal psychological processes of a parent play a critical role in the continuity of parenting.

Copyright 2006, Elsevier Science Ltd.

Taussig HN; Clyman RB; Landsverk J. Children who return home from foster care: A 6-year prospective study of behavioral health outcomes in adolescence. Pediatrics 108(1): U62-U68, 2001. (63 refs.)

Objective. Returning children to their biological families after placement in foster care (ie, reunification) has been prioritized with legislation. Comprehensive studies of child behavioral health functioning after reunification, however, have not been conducted. This study examined outcomes for youth who were reunified after placement in foster care as compared with youth who did not reunify. Design. Prospective cohort. Setting. Children who entered foster care in San Diego, California, and who remained in foster care for at least 5 months. Participants. A cohort of 149 ethnically diverse youth, 7 to 12 years old, who entered foster care between May 1990, and October 1991. Seventy-five percent of those interviewed at Time 1 were interviewed at Time 2 (6 years later). Outcome Measures. 1) Risk behaviors: delinquent, sexual, self- destructive, substance use, and total risk behaviors; 2) Life-course outcomes: pregnancy, tickets/arrests, suspensions, dropping out of school, and grades; 3) Current symptomatology: externalizing, internalizing, total behavior problems, and total competence. Results. Compared with youth who were not reunified, reunified youth showed more self-destructive behavior (0.15 vs -0.11), substance use (0.16 vs -0.11), and total risk behavior problem standardized scores (0.12 vs -0.09). Reunified youth were more likely to have received a ticket or have been arrested (49.2% vs 30.2%), to have dropped out of school (20.6% vs 9.4%), and to have received lower grades (6.5 vs 7.4). Reunified youth reported more current problems in internalizing behaviors (56.6 vs 53.0), and total behavior problems (59.5 vs 55.7), and lower total competence (41.1 vs 45.0). There were no statistically significant differences between the groups on delinquency, sexual behaviors, pregnancy, suspensions, or externalizing behaviors. Reunification status was a significant predictor of negative outcomes in 8 of the 9 regression equations after controlling for Time 1 behavior problems, age, and gender. Conclusions. These findings suggest that youth who reunify with their biological families after placement in foster care have more negative outcomes than youth who do not reunify. The implications of these findings for policy and practice are discussed.

Copyright 2001, American Academy of Pediatrics

Testa MF; Smith B. Prevention and drug treatment. Future of Children 19(2): 147-168, 2009. (65 refs.)

Evidence linking alcohol and other drug abuse with child maltreatment, particularly neglect, is strong. But does substance abuse cause maltreatment? According to Mark Testa and Brenda Smith, such co-occurring risk factors as parental depression, social isolation, homelessness, or domestic violence may be more directly responsible than substance abuse itself for maltreatment. Interventions to prevent substance abuse-related maltreatment, say the authors, must attend to the underlying direct causes of both. Research on whether prevention programs reduce drug abuse or help parents control substance use and improve their parenting has had mixed results, at best. The evidence raises questions generally about the effectiveness of substance abuse services in preventing child maltreatment. Such services, for example, raise only marginally the rates at which parents are reunified with children who have been placed in foster care. The primary reason for the mixed findings, say Testa and Smith, is that almost all the parents face not only substance abuse problems but the co-occurring issues as well. To prevent recurring maltreatment and promote reunification, programs must ensure client progress in all problem areas. At some point in the intervention process, say Testa and Smith, attention must turn to the child's permanency needs and well-being. The best evidence to date suggests that substance-abusing parents pose no greater risk to their children than do parents of other children taken into child protective custody. It may be sensible, say the authors, to set a six-month timetable for parents to engage in treatment and allow twelve to eighteen months for them to show sufficient progress in all identified problem areas. After that, permanency plans should be expedited to place the child with a relative caregiver or in an adoptive home. Investing in parental recovery from substance abuse and dependence, the authors conclude, should not substitute for a comprehensive approach that addresses the multiple social and economic risks to child well-being beyond the harms associated with parental substance abuse.

Copyright 2009, Princeton University

Thompson RG; Auslander WF. Risk factors for alcohol and marijuana use among adolescents in foster care. Journal of Substance Abuse Treatment 32(1): 61-69, 2007. (39 refs.)

This study examined the influences of individual and social risk factors on alcohol and marijuana use among a sample of foster care adolescents. Data were collected through baseline structured interviews with 320 adolescents (aged 15-18 years) who resided in foster care placements and participated in a larger evaluation study of an independent living program. Approximately 40% of the adolescents reported alcohol use, 36% reported marijuana use, and 25% reported both alcohol and marijuana use during the 6 months prior to the interview. Final logistic regression models indicated that having friends who used marijuana and other substances and having skipped school remained most predictive of using alcohol, marijuana, or both alcohol and marijuana. Recommendations for substance abuse prevention and treatment for these vulnerable adolescents are proposed.

Copyright 2007, Elsevier Science

Thompson RG; Auslander WF. Substance use and mental health problems as predictors of HIV sexual risk behaviors among adolescents in foster care. Health & Social Work 36(1): 33-43, 2011. (67 refs.)

This study examined the relationship between substance use, mental health problems, and HIV sexual risk behaviors among a sample of foster care adolescents. Data were collected through structured baseline interviews with 320 adolescents (ages 15 to 18 years) who resided in foster care placements and participated in a larger evaluation study of an HIV prevention program. Final logistic regression models indicated that delinquent behavior and marijuana use were the most significant predictors of engaging in any one HIV risk behavior. Adolescents who reported delinquent behaviors, alcohol use, and marijuana use and who were female were more likely than their counterparts to engage in vaginal sex without using a condom. Future research is needed to further identify risk and protective factors for substance use, mental health problems, and HIV sexual risk behaviors among adolescents in foster care. HIV prevention efforts for these vulnerable adolescents should target those with substance use and delinquent behaviors.

Copyright 2011, National Association of Social Workers

Thompson RG; Hasin DS. Cigarette, marijuana, and alcohol use and prior drug treatment among newly homeless young adults in New York City: Relationship to a history of foster care. Drug and Alcohol Dependence 117(1): 66-69, 2011. (39 refs.)

Background: This study examined whether a history of foster care was associated with the risk for substance use among newly homeless young adults, controlling for demographics and other risk factors. Methods: Multiple logistic regression analyses, adjusted for controls, among consecutive admissions of 424 newly homeless young adults (18-21 years), determined the association between foster care and substance use. Results: A history of foster care was reported by 35% of the sample. Alcohol, marijuana, and cigarettes were the most frequently used substances. After adjusting for demographics, childhood emotional, physical, and sexual abuse, prior arrest, unemployment, lack of high school diploma, and family drug use, homeless young adults with histories of foster care were: three times as likely to smoke cigarettes (AOR=3.09); more than three times as likely to use marijuana (AOR=3.30); and almost nine times as likely to have been in drug treatment (AOR=8.81) than those without such histories. Conclusions: It is important to screen homeless young adults who exited foster care for substance use, particularly cigarettes and marijuana. Risk reduction interventions should be targeted and tailored to their substance prevention needs.

Copyright 2011, Elsevier Science

Tyler KA; Melander LA. Foster care placement, poor parenting, and negative outcomes among homeless young adults. Journal of Child and Family Studies 19(6): 787-794, 2010. (38 refs.)

Although homeless youth with and without foster care histories both face adverse life circumstances, little is known about how these two groups compare in terms of their early histories and whether they face similar outcomes. As such, we compared those with and without a history of foster care placement to determine if the associations between a history of poor parenting and negative outcomes including depression, delinquency, physical and sexual victimization, and substance use, are similar for these two groups. The sample consisted of 172 homeless young adults from the Midwestern United States. Multivariate results revealed that among those previously in foster care, a history of physical abuse and neglect were positively associated with more depressive symptoms whereas sexual abuse and neglect were related to delinquency and physical victimization. Additionally, lower caretaker monitoring was linked to greater delinquent participation. Among those without a history of foster care, physical abuse was related to more depressive symptoms whereas sexual abuse was positively correlated with delinquency, sexual victimization, and substance use. Furthermore, lower monitoring was related to more substance use. Our findings are discussed in terms of a social stress framework and we review the implications of foster care placement for homeless young adults.

Copyright 2010, Springer

Vanderploeg JJ; Connell CM; Caron C; Saunders L; Katz KH; Tebes JK. The impact of parental alcohol or drug removals on foster care placement experiences: A matched comparison group study. Child Maltreatment 12(2): 125-136, 2007. (46 refs.)

Research has established the coincidence of parental alcohol and other drug (AOD) use and child maltreatment, but few studies have examined the placement experiences and outcomes of children removed because of parental AOD use. The present study examines demographic characteristics and placement experiences of children removed from their homes because of parental AOD use (n = 1,333), first in comparison to the remaining sample of children in foster care (n = 4,554), then in comparison to a matched comparison group of children in foster care who were removed for other reasons (n = 1,333). Relative to the comparison sample, children removed for parental AOD use are less likely to experience co-occurring removal because of neglect and physical or sexual abuse and are more likely to be placed in relative foster care. In addition, these children remain in care longer, experience similar rates of reunification, and have significantly higher rates of adoption.

Copyright 2007, Sage Publications

Vinnerljung B; Hjern A. Cognitive, educational and self-support outcomes of long-term foster care versus adoption. A Swedish national cohort study. Children and Youth Services Review 33(10): 1902-1910, 2011. (83 refs.)

The benefits and pitfalls of different forms of substitute care have rarely been evaluated in comparison with each other. In this study we compared outcomes in youth and young adulthood of long-term foster care and adoption for children who came into the Child Welfare system at a young age. We linked ten national registers with data covering ten national birth cohorts to compare cognitive, educational and self-support outcomes for 900 adoptees with 3100 who grew up in foster care. Outcomes for 900000 majority population peers were assessed for descriptive purposes. Comparisons adoptees/foster children were done in linear regression models and in Cox regression models with fixed person time. We adjusted the analyses for birth parental related selection/confounding factors (mental health problems, substance abuse and maternal education), and age at placement in substitute care. Crude outcomes for both groups were substantially weaker than for majority population peers. The foster children fell clearly short of adoptees on all outcomes: school performance at 15, cognitive competence at 18, educational achievement and self-support capability in young adult years, also after adjustments for birth parent related confounders and age at placement in substitute care.

Copyright 2011, Elsevier Science

Ward J; Henderson Z; Pearson G. One Problem among Many: Drug Use among Care Leavers in Transition to Independent Living. Home Office Research Study 260. London: Home Office, 2003. (72 refs.)

This report is one of five research reports published as part of the Vulnerable Groups Research Program. This specific report examines the way in which care leavers' drug use developed during the process of leaving state care to live independently. Care leavers face the challenge of setting up and managing a home, getting a job, coping financially and developing a support network at a very young age. The Children (leaving care) Act 2000 placed a new responsibility on social services to assist care leavers in this transition to independent living, beyond the age of 16. For a variety of reasons - adverse childhood experiences, a high incidence of psychological and behavioral problems and feelings of loss and fragmentation following time in care - young care leavers are considered particularly vulnerable to having or developing drug problems. Where drug use may have become established while living in state care, risky patterns of drug use may develop as a young person moves towards independence. This study proposes some areas where drugs services for young care leavers could be improved. Patterns of alcohol and illicit drug use are explored. A survey was conducted with 200 young people in the process of leaving care, or having recently left care, on their experiences with drugs, alcohol, and tobacco, together with other lifestyle and health issues. Thirty individuals of these participated in in-depth interviews and followed-up six months later. Findings revealed high levels of self-reported drug use but lower alcohol consumption compared with the general population.

Public Domain

Wobie K; Eyler FD; Garvan GW; Hou W; Behnke M. Prenatal cocaine exposure: An examination of-out-of-home placement during the first year of life. Journal of Drug Issues 34(1): 77-94, 2004. (46 refs.)

In a longitudinal, prospective study, three groups of infants were defined by placement status through age one: cocaine-exposed infants in out-of-home placement (n=66), cocaine-exposed infants who remained with their biological mother (n=79), and matched (race, socioeconomic status, parity, birth risk) noncocal. ne-exposed infants who remained, with their biological mother (n=141). Of this predominantly African-American, low socioeconomic status, multiparous cohort, 46%. of the women who used cocaine prenatally had infants in out-of-home placement at some time during the first year of life. The odds ratio for losing/relinquishing custody, for weeks of cocaine use during pregnancy was 6.0 (1.6, 22.0; 95% CI). More positive life experiences and higher education significantly improved the potential of retaining custody. Depression had a small but significant negative effect on the possibility of maintaining custody. The prenatal and post-partum period is an important time to provide services that encourage substance abuse recovery and associated factors of stability that facilitate an intact mother-infant dyad.

Copyright 2004, Journal of Drug Issues Inc.