Lisa is an Erickson fan :)

I personally am a big fan of the usefulness of Erickson’s theory in relationship to foster care youth/alumni, particularly when it comes to the “Intimacy vs. Isolation” stage.

• Erikson Stage 6: Intimacy vs. Isolation relates directly to the transitional stage of foster care.
• The social task of the young adult (within this model) is to create strong, long-lasting bonds of friendship and love. Those that fail in this task risk remaining isolated for the rest of their lives.
• The ability to relate to other people is affected by personal exposure to trauma. This impact is felt most deeply in an intimate relationship but also has a “ripple effect” that affects every other relationship in that person’s life.
• Research demonstrates that adults with the highest rate of broken relationships are those who shy away from emotional investment, reject any neediness in their romantic partners and withdraw during times of emotional distress.
• When young people age out of foster care, they are vulnerable. Emotionally abusive relationships might seem familiar. Predators might come to them, offering to help – and then wanting something in return. Or foster care alumni might try to isolate themselves and take on life as a “Lone Ranger.”
• If the very first emotional / physical support systems of your life disappoint you, the logical response might very well be to depend upon yourself. This will often get you through the short-term, and ensure your physical survival.
• But, if at some point, you want to commit to another person, to love and be loved by them, that might be hard. Because, in loving them, you are vulnerable to them... and that means that since they are human, there will be moments when they disappoint you. And at those times, having them fail you might bring to the surface the memories of every other time that someone from your past has failed you.
• And what do we ultimately want for foster care youth and alumni?  We want them to establish interdependent lives. We want them to build and maintain healthy relationships. We want them to learn to trust, to develop autonomy, to be industrious (aka productive), to know their worth (vs. feeling inadequate) to figure out their own identity, and to create lives of connection, rather than isolation. 

Kudos to NACAC

Kudos to the NACAC Board of Directors for passing a position statement identifying services and supports that should be provided to youth at risk of aging out of care and those who do leave care without a permanent family.

Read the statement

What If Every State Had Foster Care Medical Review Panel?

What if every state had a Foster Care Medical Review Panel, serving in a role similar to a Medical Ombudsman, that foster care youth, alumni, foster parents, CASA/GAL, etc. could contact with  concerns about over-medication?   


Forgotten Children A Special Report on the Texas Foster Care System Comptroller Carole Keeton Strayhorn (April 2004)

Findings

• DPRS exercised little meaningful oversight over the treatment of foster children with psychotropic medications.

• No formal investigation related to psychotropic medications had ever been conducted.

• YFT did not attempt to assess the appropriateness of medications.

• Many foster children were being prescribed psychotropic medications by physicians who were not trained in child psychiatry.

• Even though federal law requires a foster child’s medical records to be reviewed, updated and given to foster care providers, foster care providers of 46% children in a study conducted by the OIG never received medical histories of the children in care, including children with serious medical conditions.   Without access to a child’s medical records, it was difficult for foster parents to effectively care for foster children.

Challenges Noted:

The Advisory Committee recognized that “[c]oncerns exist regarding the inappropriate use of psychotropic medication and inadequate monitoring of prescribed medications.  


There was also a lack of data available regarding physician prescribing practices and child outcomes.  Children in foster care may be subject to widely varied standards of care.  There is currently no way to monitor the quality of care and no system for resolving concerns associated with the use of psychotropic medication for children. 


Also there is no method for “second” opinions to be easily obtained by DFPS staff when they have concerns or questions.”

In response, their plan was to:

• Develop review panels of medical professionals including (trauma-informed) child psychiatrists to provide recommendations regarding care for foster children where there is a question on whether their care is clinically appropriate.

• Establish clinical guidelines and protocols for psychotropic medications and a review process for identifying children’s medical records that fall outside the guidelines and reviewing them for inquiry or possible corrective action.

• Develop a medical and educational passport for each child that follows the child through placement changes and is readily available to healthcare providers and schools electronically.

The Financial and Societal Costs of Medicating America's Foster Children

A Senate hearing was held yesterday, "The Financial and Societal Costs of Medicating America’s Foster Children."

Mr. Bryan Samuels, Commissioner, Administration on Children, Youth and Families, U.S. Department of Health and Human Services, gave the following testimony: "During my tenure as Director, DCFS developed a comprehensive system of protocols and safeties to ensure that psychotropic medications are prescribed responsibly and monitored consistently."

This included:

• Requiring that all prescriptions be reviewed and approved at the State Deputy Director level; 

• Establishing time-limits for reviews to ensure that necessary treatment was not delayed;   

• Developing an electronic database for tracking all prescriptions for children in foster care;

• Creating “red flags” in the database that elevated certain cases, such as those in which three or more medications were prescribed, for more thorough review; and

• Establishing best practice guidelines and distributing them to prescribers. The electronic database was also designed to identify providers whose patterns of prescribing differed from the guidelines.

Here’s the link to learn more: http://hsgac.senate.gov/public/index.cfm?FuseAction=Hearings.Hearing&Hearing_id=9fc194de-2a7c-4417-8f2b-6b90cadacede

Drugging Foster Youth - Influence of Pharmaceutical Companies

Quotes from Time Magazine article: Szalavitz, Maia. Why Are So Many Foster Care Children Taking Antipsychotics?Time Magazine, November 29, 2011 .

• "The influence of pharmaceutical company marketing cannot be overlooked. Ninety-nine percent of youth receiving anti-psychotic medications in the study were given atypical anti-psychotics — the newer generation of these drugs, which are expensive and mostly unavailable in generic form and have been heavily advertised .

• "All of the major manufacturers of these drugs have been fined by the Food and Drug Administration for illegal marketing practices — in part, for marketing the drugs for unapproved use in children — with some convicted of criminal charges.

• " The main condition that antipsychotics are approved to treat —schizophrenia — is extremely rare in children . The rate of schizophrenia in children under 12 is an estimated 2 cases per 1 million children; it affects fewer than 1% of older teens. Anti-psychotics are also approved to treat bipolar disorder, a diagnosis that is highly controversial in children . Some studies suggest that it affects 0.2% to 0.4 % of children, and up to 1% of adolescents.

• And yet, between 1994 and 2003, rates of bipolar diagnoses in youth under 19 rose by a factor of more than 40, according to the National Institute on Mental Health. It seems unlikely to be a coincidence that this rise occurred during the period when atypical anti-psychotics were being illegally marketed for children ."

• "Indeed, most of the anti-psychotics used in foster-care youth were for conditions that the drugs were not approved to treat . Fifty-three percent of prescriptions were written for attention deficit/hyperactivity disorder (ADHD), a condition that is ordinarily managed with drugs that have the opposite pharmacological effects as anti-psychotics. The stimulant medications like Adderall and Ritalin, widely used for ADHD, tend to increase levels of dopamine, while anti-psychotics tend to decrease it."      

Unnecessarily Drugging Foster Care Youth

A concern that comes up again and again with foster care youth and young adults is the issue of overmedication in foster care.

 

A new study, Antipsychotic Treatment Among Youth in Foster Care , examined concomitant antipsychotic use among Medicaid-enrolled youth in foster care, compared with disabled or low-income Medicaid-enrolled youth.

They found that:

• More than a third of youth in foster care without disabilities had multiple anit-psychotic prescriptions lasting longer than 90 days
• Children who were not adopted had the highest rates of prescriptions, representing 38 out of every 100 children in foster care.

In comparison, 26 out of every 100 children who were on public assistance but not in foster care had more than one antipsychotic prescription.

In recent years, doctors and policy makers have grown concerned about high rates of overall psychiatric drug use in the foster care system. Previous studies have found that children in foster care receive psychiatric medications at about twice the rate among children outside the system. 

In 2008, the House Ways and Means Subcommittee on Income Security and Family Support held a hearing on the u tilization of psychotropic medication for children in foster car e.

In 2010, Senator Daniel Akaka (D-HI) asked the Government Accountability Office (GAO) to investigate the prevalence of prescribed psychotropic medications for children in foster care.    

Picture Books About Foster Care

HELPING CHILDREN TALK ABOUT THEIR FOSTER CARE EXPERIENCE

A Child is A Child by Brigette Weninger, 2004. After two young frogs are abandoned by their parents, Mama Mouse mobilizes the entire animal community to help care for them.

Aunt Minnie McGranahan by Mary Skillings Prigger, 1999. Based on a true story; when nine orphans came to live with her, Aunt Minnie came up with a solution: "The oldest looked after the youngest, the ones in the middle looked after each other, and Aunt Minnie looked after them all.”

A Father Like That by Charlotte Zolotow, 2007. A boy growing up without a father lists the activities that he wishes they could share, and decides to grow up and become the type of father that he never had.

Foster Parents by Rebecca Rissman, 2011. Describes what foster families are and how they care for children who need help until they return to their original families or move on to a permanent family.

Goodbyes by Shelley Rotner, 2002. Simple text, accompanied by photos, explains that sometimes people live in more than one home, and that goodbyes might not be forever, but might be just “bye for now.”

Kids Need to be Safe by Julie Nelson, 2005. This book is designed to help foster children understand why they aren’t currently with their biological parents, and offer them hope and reassurance.

Let’s Talk About When Your Parent is in Jail by Maureen K. Wittbold, 1997. Having a parent in jail can be one of the reasons that children enter foster care. This book answers many questions that children can be harboring.

Maybe Days: A Book for Children in Foster Care by Jennifer Wilgocki and Marcia K. Wright, 2002. Provides a simple explanation for children in foster care about the processes impacting their lives, and acknowledges the questions for which there is no easy answer, such as: “When am I going home?”

A Mother for Choco by Keiko Kasza, 1992. A motherless bird searches for the right place to belong – and finally finds it with Mrs. Bear, who takes Choco into her loving home and introduces him to his new siblings.

Murphy’s Three Homes by Jan Levinson Gilman, 2008. A puppy who moves from home to home learns that it is not his fault, and finds a family who will love him even if he struggles to obey their rules.

My Dog Is As Smelly As Dirty Socks by Hanoch Piven, 2007. During their time in foster care, children often create Life Books with pictures and stories about their biological families. This book, while not specifically geared towards foster care, suggests creative collage techniques that might work well in Life Books. 

Our Gracie Aunt by Jacqueline Woodson, 2002. Initially reluctant to open the door to a social worker asking how long their mother has been gone, two children find comfort and safety at their Aunt Gracie’s house.

When I Miss You by Cornelia Maude Spelman, 2004. Various situations can cause a child to be separated from parents – for a short or long time. This book is a tool for caregivers to assist children of all backgrounds to share what it feels like to miss someone and problem-solve what to do while waiting to be reunited.

15% of Ohio Foster Youth "Age Out" of Care

According to Table 3: States with largest percent of total exits due to youth aging out (FY 2009):

1,453 Ohio youth "aged out" of foster care in 2009

Did You Know About This Progress in Florida?

Normalcy for Foster Care Youth
"For many years youth in state care were not able to participate in the same types of activities as their peers. In order to fix that problem, the state is now required to include a “normalcy” component in the case plan.

According to Fla. Admin. Code 65C-30.007(10), youth should be encouraged and supported in taking part in extracurricular activities, obtaining work, attending social events, learning how to drive and doing all the other normal things that youth do.

Preparation for Adulthood
Florida law requires that transition planning begin for youth in state care at age 13 with the adoption of an education or career plan The state is required to conduct a “pre-independent living assessment” for all youth between the ages of 13 and 15.

It should then identify services needed to meet the needs identified in the assessment. The state must then conduct a staffing once a year to ensure that the youth receives the services and training necessary to develop independent living skills. Florida Statute §409.1451(4)(a).

Forging An Education and Career Path
Beginning at age 13, the youth’s case plan must include “an educational and career path” component based on the abilities and interests of each child. Florida Statute §409.1451(3) (b)1.

This path must be incorporated in the case plan and must be reviewed at each judicial hearing. The youth, assisted by foster parents and DCF or the CBC, must chose one of these post-secondary goals:
1. Obtaining a 4-year university degree.
2. Obtaining a 2-year college degree.
3. Obtaining a career/technical certificate.
4. Beginning employment or apprenticeship after completing high school or enlisting in the military.

How does YOUR state rate regarding Child Welfare Outcomes?

Check out the Child Welfare Outcomes Report Data Customer Report Builder and find out...

State of Homelessness in America

The National Alliance to End Homelessness recently released a report, The State of Homelessness in America, indicating that:

• Homelessness is on the rise
• Youth aging out of foster care are among the four populations most likely to go without shelter
• In the course of a year, the estimated odds of experiencing homelessness for a young adult who ages out of foster care are 1 in 6

Jesus, Stephen Colbert, and Helping the Poor in 2011

Quotes from Stephen Colbert in response to recent comments by Bill O'Reilly regarding exactly what society owes to the have-nots:

• "What I like best about Bill's  argument is its complete factual inaccuracy. Because it would be inconvenient for guys like us to repeat what Jesus actually said."

• "For instance, if someone wants your coat, give them your cloak as well. Rich people should sell all their possessions and give the money to the poor. Plus, the fact is, Jesus was WAY beyond self-destructive; he was SELF-SACRIFICIAL."

• "Plus, Jesus was always flapping his gums about the poor - but not once did he call for tax cuts for the wealthiest two percent of Romans."

• "And don't forget - Jesus hung out with tax collectors and prostitutes - and no good Conservative would be caught dead with tax collectors."

• "What really frightens me about this is now we've got a liberal Jesus seated at the right hand of the Father...

• "Because if this is gonna be a Christian nation that DOESN'T help the poor, either we've got to pretend that Jesus is just as selfish as we are, or we've got to acknowledge that he commanded us to love the poor and serve the needy without condition - then admit that we just don't want to do it."

Challenges faced by LGBTQ youth in foster care

The Family Acceptance Project, a comprehensive study of LGBT youth and their families discovered that nearly half of the foster care youth in their study had been removed from their homes, run away or were thrown out of their homes because of their sexual orientation or gender identity.

A 2001 study by the Urban Justice Center found that:

• Once placed in a foster care setting, 78 percent of LGBTQ foster youth were forced to leave their foster placements due to anti-LGBT violence and harassment.

• Fifty-six percent of LGBTQ youth interviewed in the study had spent time living on the streets because they felt safer there than they did living in their group or foster homes.

Feinstein, R., Greenblatt, A., Hass, L., Kohn, S., Rana, J. (2001). Justice for all? A report on lesbian, gay, bisexual and transgendered youth in the New York juvenile justice system. New York: Lesbian and Gay Project of the Urban Justice Center. Ryan, C., Diaz, C. (2005). Family responses as a source of risk and resiliency for LGBT youth. Paper presented at the Preconference Institute on LGBTQ Youth, Child Welfare League of America 2005 National Conference, Washington, DC.

It's Not Too Late to Apply for HUD's Family Unification Program

The U.S. Department of Housing and Urban Development (HUD) has given public housing authorities nationwide until December 1, 2010 to apply for Section 8 Housing Choice Vouchers through the Family Unification Program (FUP).

• FUP vouchers can be used to help foster youth with their housing needs in transitioning from foster care to adulthood.

• For FUP vouchers to be successful, and for youth to actually receive this assistance, child welfare organizations must build a strong partnership with their local housing authorities.

Learn more at the National Center for Housing and Child Welfare.

Generation Why

• There are over 1.6 million homeless youth living in America every year (1 in 50 American children)

• Over 50% of youth in shelters and on the streets report that their parents told them to leave or knew they were leaving and did not care. 

• 1 in 4 homeless youth come from the foster care system

• 33% of heterosexual homeless youth have been sexually abused

• Around 400,000 homeless youth are gay, lesbian, bi-sexual or transgender, in which 58% have been sexually abused

• 1 in 7 homeless children have moderate to severe heath conditions

• Less than 1 in 4 homeless children will graduate from high school

• Every day 12 kids die on the streets of America

Learn how YOU can make a difference at  http://genwhymovie.com/

Three Research Briefs re: Foster Care & Educational Outcomes

 Opening Doors to Higher Education for Youth in Foster Care
The Schuyler Center for Analysis and Advocacy Policy Brief (March 2010) discusses the difficulty for youth in care in going to college. This brief outlines financial aid reforms that are necessary to help as these youth attempt to get a postsecondary education.

http://www.scaany.org/documents/cpa_policybrief_highereduc2_may2010.pdf

Foster Youth Education Initiative Releases Report on Improving Opportunities for Foster Youth
Foster youth lack parental advocates to monitor their academic progress, attend parent-teacher conferences, enroll them in appropriate classes, and ensure they receive a quality education. As a consequence, they often fail to receive the opportunities necessary to succeed in school.

NCYL’s Foster Youth Education Initiative (http://www.fosteredconnect.org/) has released its long-awaited report on how California is ensuring that foster children receive academic opportunities by creating educational advocacy systems for youth. This report includes overviews of 11 models, and concrete recommendations to improve outcomes.

http://www.youthlaw.org/fileadmin/ncyl/youthlaw/education/CA_Education_Advocacy_Systems_1_.pdf

Addressing the Unmet Educational Needs of Children and Youth in the Juvenile Justice and Child Welfare Systems
This report, published by Georgetown Public Policy Institute’s Center for Juvenile Justice Reform, discusses the poor educational outcomes that many child welfare and juvenile justice involved youth face:

http://cjjr.georgetown.edu/pdfs/ed/edpaper.pdf

Permanent Supportive Housing and Evidence-Based Practice

After many years of development, the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) National Center for Mental Health Services has finalized and posted a Supportive Housing Toolkit.

While this kit was developed specifically to assist individuals with mental health needs in attaining supportive housing, my hope is that some of the research and best practices found in this toolkit might be applicable to transitional youth, particularly emancipated foster care youth, as well...

• How to Use the Evidence-Based Practices KITs 
• Getting Started with Evidence-Based Practices
• Building Your Program
• Training Frontline Staff
• Evaluating Your Program
• Using Multimedia to Introduce Your EBP
• Tools for Tenants
• Brochure
• Introductory Powerpoint - available for free download at SAMHSA
• The Evidence

My So-Called Emancipation: From Foster Care to Homelessness for California Youth

Human Rights Watch has released a new report about California youth in foster care with some startling results: At least 20 percent of the 4,000 who are released from foster care each year end up homeless.

Through interviews with 63 young people who became homeless after leaving foster care, it was evident that factors leading to homelessness include "missed opportunities to learn skills, lack of ability to support themselves, a shortage of second chances, and the fact that no one cared what happened to them."

The Marshmellow Test - and Young Adult Outcomes

Oh, The Temptation from Steve V on Vimeo.

After the initial study, by Professor Walter Mischl, researchers continued to track these children throughout their school careers and into early adult life. The results were dramatic:

"Those who had deferred eating the marshmallow for 15-20 minutes in order to get the bigger prize just a few minutes later were more socially competent, personally effective, self-assertive and better able to cope with the frustrations of life.


"They were less likely to go to pieces, freeze, regress under stress or become rattled and disorganized when pressured. They embraced challenges, and pursued them instead of giving up even in the face of difficulties; they were more self-reliant and confident, trustworthy and dependable; they took initiative and plunged into projects. This group even scored on average 210 points higher on their SAT."

America's Runaway and Homeless Youth

Quote from Chapin Hall's (freely available for listening) webinair:

"Many runaways become homeless because family reunification is not an option. Other young people end up on the street or in a shelter because they are abandoned by their parents, are forced to leave home, age out of foster care, or are released from the juvenile justice system."