Development of Ecological Mental Health Services for Foster Children

Purpose: Findings from a study funded through a NIMH K-01 award is presented. This study is focused on the development of a mental health services model for foster children with behavior problems. Problems with access and the content of the mental health services provided to foster children are significant. Although 27% of children in family foster care have received some type of mental health service in the past 12 months, 76% of children with clinically significant symptoms who have contact with child protections have not received services in the past year (Burns et al., 2004). Entry into the child welfare system provides children with unique resources, such as greater access to assessments and case management, but also significant barriers to receiving adequate mental health services. For example, although caregiver involvement is needed for effective treatment of many disorders (Brannan, 2003), foster parents rarely participate in treatment (Leathers et al., 1998; Leslie et al, 2000).

Research Methods: An ecological model of service provision has the potential to address issues of low access to services, infrequent caregiver involvement, and poor follow through with services. By providing services in the child's living environments and engaging caregivers and teachers as participants in service provision, changes in the immediate contingencies to children's behavior could lead to sustained improvements in behavior problems. To understand how to develop this type of service model, a planning study was initiated with a large child welfare agency. Initially, four agency administrators were engaged in planning meetings. In these meetings, foster parents' lack of involvement in services was identified as a major barrier to providing effective services. To address this issue, a home visiting model was proposed.

Results: We held two focus groups with caseworkers (N = 8) and foster parents (N = 10) to understand caseworker and foster parent perspectives on the proposed home visiting model and the feasibility of caseworkers using the materials during home visits. Interviews were transcribed and then analyzed using Atlas-ti by two doctoral students and an MSW. Two coders independently coded each transcription. Meetings between the coders to modify codes and reach consensus resulted in a single version. A third coder received a brief training and then coded the interviews independently to assess reliability.

Identified themes supported the need for support and training of both foster parents and caseworkers. In addition, many foster parents viewed caseworkers and their children's therapists as often unhelpful and intrusive, pointing to the need to build positive relationships and provide caseworkers with tools to provide meaningful support to foster parents. A theme of tension between the system's protection of the child and the foster parent's ability to parent indicates the need for policies that provide greater support of the foster parent's parental role. Conclusion: The themes provide support for a service model that addresses foster parents' needs as they attempt to parent within the constraints of the child welfare system. The relevance of the K-01 funding mechanism to the type of research presented will be discussed.