GOING BEYOND FOSTER CARE

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1 GOING BEYOND FOSTER CARE Sharon W. Cooper, MD Developmental & Forensic Pediatrics, P.A. University of North Carolina Chapel Hill School of Medicine

2 OBJECTIVES Adverse childhood experiences can and often do result in high risk behaviors, particularly in children in foster care. Such children have a higher incidence of mental health conditions which can hinder successful navigation of life after foster care. Pediatricians can play a pivotal role in educational success for these children.

3 AGING OUT Since 1999, the number of children in foster care has been decreasing, though the number of children aging out, has remained stable over the past 10 years. In 2014, DHHS noted that from , ~ 262,730 young people aged out of foster care, at a steady rate of about 20,000 children per year. Contrary to popular belief, the average age of a child in foster care is over 9 years old. The average amount of time spent in foster care is 2 years, but 10% of children remain for 5 years or longer.

4 Adverse Childhood Experiences determine the likelihood of the ten most common causes of death in the United States.

5 TOP 10 RISK FACTORS Smoking Alcoholism Severe Obesity Illicit Drug Use Physical Inactivity Injected Drug Use Depression 50+ Sexual Partners Suicide Attempts History of STDs

6 THE ACE QUESTIONNAIRES Originally, the ACE questionnaires were designed to be completed at home, before a person was medically evaluated This is in contrast to a typical medical visit which begins with taking a medical history, then examining a patient, obtaining symptom related studies and then having another visit for conclusion

7 INSTEAD, EVEN THE SHORTER VERSION Helps people to rate the extent of trauma they have experienced in childhood and to predict the likelihood that she or he will experience one or more forms of health, behavioral, and/or social problems. The trauma are in the areas of abuse: (psychological (by parent), physical (by parent) or sexual (by anyone) and/or Household dysfunction: substance abuse, mental illness, mother treated violently or imprisoned household member.

8 CASE EXAMPLE L.P. grew up in a family with severe IPV, and having been the victim of CSA by her mother s boyfriend, she was placed in the foster care system at the age of 11. She became a homeless youth at about 16 and was recruited from a shelter by a trafficker who sexually assaulted her and threatened to harm her while exposing her to his violent behaviors towards other girls that he had living in his hotel room. LP described having had long term depression, anxiety and PTSD from the CSA and she was a compliant victim to the trafficker for alcohol and cocaine use. She was able to run away after 3 months of his control during which she had a 2 nd trimester miscarriage of an unplanned pregnancy.

9 Childhood Experiences vs. 18 Adult Alcoholism % Alcoholic ACE Score

10 Adverse Childhood Experiences vs. Likelihood of > 50 Sexual Partners 4 Adjusted Odds Ratio or more ACE Score

11 Adverse Childhood Experiences vs. History of STD 3 Adjusted Odds Ratio or more ACE Score

12 Adverse Childhood Experiences vs. Current Smoking % or more ACE Score

13 FOSTER CARE HEALTH RISKS Research has shown that this population includes children with more complex physical, mental and emotional health care needs then the general Medicaid population. As a group they have: More chronic health problems. A higher incidence of congenital disorders and birth defects. An increased incidence of problems with developmental and growth delays. More mental health problems.

14 BARRIERS TO A HEALTHY MENTAL STATE The impact of foster care and the process of aging out has both psychological as well as behavioral impact. Contributors include the lack of financial, emotional, educational and protective support typically found in permanent or intact families. Consequently, children aging out often try to reconnect with family but without planning, preparation and clinical support, the results are often very problematic.

15 BARRIERS TO A HEALTHY MENTAL STATE Children in foster care internalize what surveys reveal as a culture of no i.e. things taken for granted by peers such as faith practices, participating in sports, getting senior pictures taken or joining friends family special outings. Denials are often by foster families, group homes or GAL because of custodial system requirements. Eventually, foster care youth stop asking often resulting in a pervasive sense of social despair.

16 BARRIERS TO A HEALTHY MENTAL STATE Children approaching aging out speak of fractured foster care family relationships worsened by: Separation from biological siblings Sibling visits of 1 hour/week in a building waiting/visiting area Experiencing being sent to respite care when foster care family goes on trips or vacations

17 BARRIERS TO A HEALTHY MENTAL STATE On a day-to-day bases, youth feel different from their peers Being in foster care is stigmatizing particularly if they are in congregate care (group homes) They experience early curfews, no sports or after school activities Many experience a level lifestyle: Zero Level on entry ~ like lock down Privileges must be earned such as having a sibling visit Top level would be a chance to use electronics or get paid for chores

18 FOSTER CARE CONSEQUENCES Aging out of foster care at the age of 18 is somewhat of a recipe for failure. Systems recognize that children cannot care for themselves at this point in their social and cognitive development, even if they were enrolled in secondary education, primarily because of meager social capital relationships rooted in family, school, peer and community networks.

19 UNINTENDED CONSEQUENCES Children who have had adversities have a higher incidence of running away from home or from a foster care home and this can lead to a series of losses (multiple placements) that affect a youth s sense of permanence or having any kind of enduring relationship across the life course. High risk behaviors can contribute to cross-over kids ~children who are in both the child welfare system as well as the juvenile justice system.

20 MENTAL HEALTH PROBLEMS NOTED IN CROSSOVER KIDS Conduct Disorder Depression Disorders Gender and sexual orientation issues Suicidality and Non-suicidal selfharm Mood Disorders Substance use and abuse

21 EXTENDED FOSTER CARE The Fostering Connections to Success and Increasing Adoptions Act of 2008 provides states with the option of extending foster care to 21 with federal financial support. As of 2014, 24 states had adopted extended foster care. Best practices include sustaining social capital, providing permanency supports and assisting with postsecondary opportunities.

22 COMPLEX TRANSITION NEEDS: [1] SUSTAINABLE SOCIAL CAPITAL The ability to navigate resources, build relationships, and develop a community is sustainable social capital. Youth transitioning from foster care often lack critical support networks and healthy relationships to achieve this. Ideal programs and policies emphasize strong connections with a supportive adult, developmentally appropriate services, and opportunities for youth voices in transitional planning.

23 MODEL PROGRAMS PROMOTING SUSTAINABLE CAPITAL Youth Villages Transitional Living Program Southern California s Foster Family and Adoption Agency Oregon Foster Youth Connection

24 COMPLEX TRANSITION NEEDS: [2] PERMANENCY SUPPORTS Housing Transportation Healthcare Without these supports, youth in transition cannot maintain education Without these supports, youth in transition cannot maintain employment

25 MODEL PROGRAMS FOR PERMANENCY SUPPORT Covenant House Jim Casey Youth Opportunities Initiative John Burton Foundation s California Transitional Housing Program National Center for Housing and Child Welfare

26 COMPLEX TRANSITION NEEDS: [3] POSTSECONDARY OPPORTUNITIES Youth in transition should know about and be able to access a range of postsecondary opportunities including two-year and four-year education. Of those who enroll in a four-year college, less than 10% are able to complete their education because of persistent difficulties. Youth also need access to workforce training programs

27 MODEL PROGRAM FOR POSTSECONDARY OPPORTUNITIES NPowering My Success Program at the university of Michigan-Flint Foster Forward in Rhode Island Guardian Scholars

28 SUMMARY Best practices include sustaining social capital, providing permanency supports and assisting with postsecondary opportunities. There are numerous model programs in the U.S. and a consistent component is taking pro-active measures to assure access to : Healthcare Housing Transportation

29 SUMMARY Aging out of foster care is a difficult and daunting process associated with significant negative life experiences for youth and young adults. State adoption of federal funds to provided extended foster care for youth until 21 is a first step in aiding youth in the aging out process. Improved outcomes occur with there are youth voices in planning support of youth in the transition process from foster care.

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