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Many foster parents are challenged by the social-emotional consequences of children in foster care who have experienced childhood trauma. In this project, we provided foster parents with a trauma-informed, evidence-based parenting program (Incredible Years; IY) and assessed its impact on child behavior, foster parent stress and attitudes, and perceived effect on parenting. Foster parents of children aged 2–7 yrs. were randomly assigned to IY intervention or control groups. We assessed pre-post child behavior, parenting stress, and parental attitudes. A subset of intervention foster parents completed post-intervention focus groups and in-depth interviews. Main themes from qualitative data (3 focus groups; 5 interviews; total n = 12) revealed that IY foster parents perceived changes in their parenting that they attributed to the peer support, new perspectives on the value of play, and specific tools that enhanced parenting skills. These parenting skills improved family relations and were sustained over time. Quantitative data, however, did not as strongly support program effectiveness. Between the IY (n = 16) and control (n = 17) groups, foster parents were less likely to perceive their foster child in need of mental health treatment (p = 0.002), and changed their perception of their child's role in the family (p = 0.03). No between group differences were found for measures of child behavior or parent stress. Overall, these results suggest that trauma-informed IY for foster parents may provide unique peer support and increased confidence needed to implement strategies that can improve intra-family relations. Further research is needed to verify whether and how these relations are improved.

Prior research suggests that for youth in the general population, involvement in activities improves academic, health and social outcomes, but the impact of these activities on youth in out-of-home care is unknown. This study examines, among youth in foster, formal kinship, and residential care, associations between involvement in structured and unstructured activities and social and mental health measures. Among 134 youth in out-of-home care, only 40% were involved in structured activities, and racial/ethnic minorities and males were even less likely to participate (p ≤ 0.01). More youth reported involvement in general physical activity (76%), which was associated with higher social skills when compared to those not involved in such unstructured activity (b = − 10.4; 95% C.I. = − 18.22, − 2.65, p = 0.09). Youth not involved in structured activities showed poorer performance on measures of loneliness (b = 5.6; 95% C.I. = 1.63, 9.47, p = .006), drug abuse (b = 0.95; 95% C.I. = 0.31, 1.59, p = .004), and depression (b = 3.5; 95% C.I. = .25, 6.76, p = 0.04). Participation in activities, particularly when structured, may help these vulnerable youth to achieve better social relationships and mental health.

Objective To determine whether systematic use of a validated social-emotional screening instrument in a primary care setting is feasible and improves detection of social-emotional problems among youth in foster care. Methods Before-and-after study design, following a practice intervention to screen all youth in foster care for psychosocial problems using the Strengths and Difficulties Questionnaire (SDQ), a validated instrument with 5 subdomains. After implementation of systematic screening, youth aged 11 to 17 years and their foster parents completed the SDQ at routine health maintenance visits. We assessed feasibility of screening by measuring the completion rates of SDQ by youth and foster parents. We compared the detection of psychosocial problems during a 2-year period before systematic screening to the detection after implementation of systematic screening with the SDQ. We used chart reviews to assess detection at baseline and after implementing systematic screening. Results Altogether, 92% of 212 youth with routine visits that occurred after initiation of screening had a completed SDQ in the medical record, demonstrating high feasibility of systematic screening. Detection of a potential mental health problem was higher in the screening period than baseline period for the entire population (54% vs 27%, P Conclusions Systematic screening for potential social-emotional problems among youth in foster care was feasible within a primary care setting and doubled the detection rate of potential psychosocial problems.

Despite known high rates of mental health problems among children in foster care, these problems are often not identified promptly by primary care or other systems. A novel delivery system is a centralized primary care practice for foster care. The purpose of this study was to examine the identification of mental health within two pediatric medical homes for foster care. We conducted a retrospective medical chart review of all children, aged 6–18 years, newly entering foster care, in two foster care clinics serving two county-wide populations. Our sample of 242 children describes demographics, rates for mental health problem identification, and length of time after entering foster care that mental health needs were identified. We used logistic regression analyses to examine variables associated with identification of mental health needs. Both centralized foster care medical homes had high rates for identification of mental health problems (> 70% in both sites), timely identification (the majority identified within two months after entry into care), and high mental health referral rates for children entering foster care (> 70%). Our findings suggest that attention to mental health needs for children in foster care within their primary care setting can impact identification rates and management of mental health.

Objective To study the relationship between experiencing separation from parents and having learning difficulties among children in a community-based sample. Methods In 2003, parents of children entering kindergarten in the city of Rochester completed a survey assessing the child's social background, medical history, and behavioral profile. Children separated from parents for >1 month were compared with those who had never been away for >1 month on 4 validated developmental measures (range, 1–4): a learning scale, an expressive language scale, a preliteracy scale, and a speech scale. Bivariate analyses and multivariate logistic regression analyses were used to determine associations between separation from parents and learning difficulties. Results Among the 1619 children, 18% had been separated from a parent for >1 month at least once (11% once, 7% ≥2 times). Separated children scored worse compared with those without separations on learning (3.14 vs 3.28, P = .001) and preliteracy (2.21 vs 2.35, P = .03). Higher rates of learning difficulties (26.7% vs 16.7%, P P = .01) were noted among those who had been separated versus those who had not. In multivariable modeling, separation was associated with learning problems (adjusted odds ratio, 1.71; 95% confidence interval, 1.18–2.49) and preliteracy problems (adjusted odds ratio, 1.46; 95% confidence interval, 1.04–2.05) when adjusted for demographic, medical, and social factors. Conclusions Urban children who have experienced separation from a parent may have more learning difficulties at entrance to kindergarten. Screening and intervention practices to remedy these challenges may better equip such young children to succeed when they enter school.

SOMETIMES AMOMENT can alter your life. For me, one such moment came in the middle of residency. I was moonlighting at the local health department—as residency obligations permitted—just 2 hours a week, seeing children and teens in foster care for their “annual exam.” The clinic provided basic care for about 200 of the 1200 children and teens in foster care in our county. Back then, the clinic operated very differently. Every patient got a 9 AM appointment time and was given a number by which they were called back for what amounted to a brief physical. The nurses took the histories. I spent my first few weeks there working on some changes—providing individual appointment times, using names instead of numbers, and obtaining health histories myself. Each time I went, I was greeted by Eleanor, a veteran nurse who often said to me, “These children deserve better.” But it wasn’t until I met 16-year-old Jason, around my sixth week at the clinic, that I truly understood what Eleanor meant. Jason came in on a sunny Thursday morning. During our visit, I learned that he had asthma but had no idea of what his triggers were, how to use his medications, or even what medications hewas on. It was a quiet morning, so I took the time to teach him about asthma: how to identify and monitor his symptoms, take his meds, and when to call for help. Jason was bright and articulate and caught on quickly. I learned he had been in the same foster home for nearly 16 years, with a family he enjoyed and felt part of. We must have spent about 40 minutes together, including time to write new prescriptions. I finally had my hand on the doorknob, ready to leave the room, when I turned and asked him what I often asked my patients at the end of a visit, “Is there anything else I can do for you today?” The room developed that quiet stillness that tells you something important is about to occur. I stood waiting, my hand on the door, as Jason sat, looking at me, assessing and thinking. I waited some more, a bit impatient to move on, a bit uncertain and anxious about what was coming. Finally, after what was surely no more than seconds, but felt like minutes, he replied, “Yes. You can tell me what I did when I was 6 months old to be put in foster care.” I could feel in the space between us how hard it was for him to ask this question, and how much pain and hurt lay behind the words. It hit me then how little I knew about