Mental health outcomes in children in foster care improved with mentoring, skills development

Children who have been maltreated and placed in foster care are at risk for significant mental health problems including depression, posttraumatic stress, dissociation, social problems, suicidal behavior, attention-deficit/hyperactivity disorder and conduct disorders, according to background in the article. As well, studies of Medicaid claims suggest that as many as 57 percent of youths in foster care meet criteria for a mental disorder. Additional background information suggests that although children in foster care are in significant need of mental health services, the majority of these children do not receive the necessary treatment.

Heather N. Taussig, PhD, associate professor, and Sara E. Culhane, PhD, JD, research senior instructor, both with the Kempe Center for the Prevention and Treatment of Child Abuse and Neglect at the University of Colorado School of Medicine, studied 156 children ages 9 to 11 years in the Denver area who were maltreated and placed in foster care. Participants were randomly placed in a control group (77 children) or intervention group (79 children). Children and their caregivers were interviewed prior to randomization, immediately following the intervention and again six months later.

The study, conducted from July 2002 to January 2009 in two Colorado counties, evaluated the Fostering Healthy Futures (FHF) preventive intervention program that was developed at the Kempe Center. The FHF program consisted of two components: skill development groups and one-on-one mentoring by graduate students in social work. The skills group followed a standardized curriculum that combined traditional cognitive-behavioral skills group activities with process-oriented materials and included weekly activities that encouraged children to practice newly learned skills with their mentors. The curriculum worked to build skills in specific areas including emotion recognition, problem solving, anger management, healthy relationships, peer pressure and abuse prevention.

According to the authors, after adjusting for covariates, intent-to-treat analyses demonstrated that the treatment group had fewer mental health problems on a multi-informant factor six months after the intervention. Additionally, children in the treatment group reported fewer symptoms of dissociation six months after the intervention and also reported better quality of life immediately following the intervention. There was also a trend suggesting that youths in the treatment group were less likely to report symptoms of posttraumatic stress than those in the control group.

"These findings suggest that even for the most vulnerable children, rigorous intervention efforts can make a difference and may lead to better outcomes and healthier futures," said Taussig.

"We are delighted to be able to have children from our county participate in the Fostering Healthy Futures program," said Janis L. James, LCSW, program manager, Ongoing Child Protection, Adams County Human Services Department. "While the long-term benefits are yet to be fully understood, we see lots of promise for those youth who have gone through the program, and deeply value the focus on improving social, coping and problem-solving skills -- tools that will help these youth in life regardless of what may happen after they leave the child welfare system."

This study was supported by grants from the National Institute of Mental Health and also received funding from the Kempe Foundation, Pioneer Fund, Daniels Fund and Children's Hospital Research Institute.