Adolescent out of-home placement-ml


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Adolescent out of-home placement-ml

  1. 1. Adolescent Out-of-Home Placement <ul><li>Melissa Luke </li></ul><ul><li>Ecological Counseling </li></ul><ul><li>November 1, 2005 </li></ul>
  2. 2. <ul><li>“ In every child who is born, </li></ul><ul><li>under no matter what circumstances </li></ul><ul><li>and of no matter what parents, </li></ul><ul><li>the potentiality of the human race </li></ul><ul><li>is born again.” </li></ul><ul><li>James Agee </li></ul>
  3. 3. 500,000+ children and adolescents are currently in government funded out-of-home care <ul><li>Foster care </li></ul><ul><li>Residential treatment </li></ul><ul><li>Juvenile detention </li></ul>
  4. 4. <ul><li>Robust research examining services provided, recipients of service, and relevant outcomes within each out-of-home placement setting </li></ul><ul><li>Paucity of literature incorporating adolescent self-report of experiences in out-of-home placement </li></ul><ul><ul><li>Attkinson & Zwick (1982) developed client satisfaction questionnaire; no evidence of its use with adolescents </li></ul></ul><ul><ul><li>in out-of-home placement </li></ul></ul><ul><ul><li>Garland, Aarons, Saltzman & Kruse (2000) </li></ul></ul><ul><ul><li>Multidimensional Adolescent Satisfaction Scale (MASS) </li></ul></ul>Current research
  5. 5. Out-of-home placement decisions <ul><li> Are </li></ul><ul><li>Voluntary/Involuntary </li></ul><ul><li>(parental decision) </li></ul><ul><li>Short-term/ Long-term </li></ul><ul><li>Single/ Multiple </li></ul><ul><li> Can be </li></ul><ul><li>Be selected to meet adolescent’s needs </li></ul><ul><li>Be detailed and explicit in plan </li></ul>
  6. 6. <ul><li>Many of the adolescents in out-of-home care have experienced </li></ul><ul><li>Multiple placements over a number of years </li></ul><ul><li>Numerous mental health and/or social services contacts prior to placement </li></ul><ul><li>73% have history of neglectful, abusive or otherwise chaotic and dysfunctional homes </li></ul><ul><li>Sexual abuse; estimated 80% female residents </li></ul><ul><li>15-56% didn’t finish high school or earn GED </li></ul>
  7. 7. Factors related to placement <ul><li>Race was strongest predictor </li></ul><ul><li>Neither low income or receipt of public assistance alone increased risk </li></ul><ul><li>Psychiatric history, prior child placements and legal system involvement increased risk </li></ul>
  8. 8. Foster care <ul><li>Protective placement </li></ul><ul><li>Social service/ child welfare </li></ul><ul><li>Ranges from 1-3 days to years </li></ul>
  9. 9. Adolescents removed from home as a result of <ul><li>Parent unwilling or unable to cope with parenting demands </li></ul><ul><li>Parental abuse </li></ul><ul><li>Parental neglect </li></ul>
  10. 10. Foster Care Population <ul><li>275,000+ youth in foster care in 1985 </li></ul><ul><li>470,000+ youth in foster care in 1995 </li></ul><ul><li>30% youth in kinship care (relative licensed or approved as foster parent) </li></ul><ul><li>Foster youth tend to be placed in care younger than residential or juvenile justice placements </li></ul>
  11. 11. Demographics <ul><li>African American youth significantly overly represented: </li></ul><ul><ul><ul><ul><ul><li> 45% African American </li></ul></ul></ul></ul></ul><ul><li> 37% Caucasian </li></ul><ul><li> 11% Hispanic </li></ul><ul><li>African American youth average 2 years longer in care longer than white youth </li></ul><ul><li>(Kapp, 2000) </li></ul>
  12. 12. Mental health <ul><li>Estimated 35-85% youth in foster care have had emotional disturbance </li></ul><ul><li>Adjusted mental health utilization rate is 28 times that of peers </li></ul><ul><li>(Yancey, 1998) </li></ul>
  13. 13. Placement breakdowns <ul><li>Breakdowns occur through: </li></ul><ul><li>Care giver refusing to continue further care </li></ul><ul><li>Adolescent runs away </li></ul><ul><li>Authorities end placement due to inferior care </li></ul><ul><li>Parental decision/ disagreement over care </li></ul><ul><li>Ostensible agreement, but possible cover-up </li></ul><ul><li>(Vinnerljung, Sallnas & Westermark, 2001) </li></ul>
  14. 14. Increased risk for breakdown <ul><li>More breakdowns in non-related foster care than in kinship homes & in private residential care settings compared to publicly owned facilities </li></ul><ul><li>Adolescents placed further from birth family have higher incidence of breakdown </li></ul><ul><li>Adolescents placed due to antisocial behavior had most breakdowns & adolescents with a psychiatric diagnosis the next highest number of breakdowns </li></ul><ul><li>Adolescents having a history of earlier placement breakdown, more likely to experience another subsequent breakdown </li></ul>
  15. 15. Consequences of foster care placement <ul><li>Exacerbate emotional/ behavioral problems exhibited by adolescent prior to removal </li></ul><ul><li>Restricted affective-rage, grief, sadness, despair </li></ul><ul><li>Disrupted or conflictual emotion bonds (attachment) </li></ul><ul><li>Educational deficits as compared to peers </li></ul>
  16. 16. <ul><li>Emotional, behavioral or psychiatric placement </li></ul><ul><li>Chemical dependency placement </li></ul><ul><li>Residential treatment setting </li></ul><ul><li>Parental consent </li></ul>Residential treatment
  17. 17. Demographic information <ul><li>missing data and numbers can be misleading </li></ul><ul><li>settings are both public and private placements </li></ul><ul><li>population tends to be revolving </li></ul><ul><ul><li>30-60% African American </li></ul></ul><ul><ul><li>45-55% White </li></ul></ul><ul><ul><li>Average age 14.8 years old </li></ul></ul>
  18. 18. Population <ul><li>Relatively evenly distributed across sex, slightly more males to females </li></ul><ul><li>However symptoms and diagnoses linked with gender </li></ul><ul><li>67% internalizing disorder </li></ul><ul><li>43% externalizing </li></ul><ul><li>33% both </li></ul><ul><li>14% neither </li></ul>
  19. 19. Juvenile Justice <ul><li>Correctional placement </li></ul><ul><li>Adjudicated </li></ul><ul><li>Delinquency/ PINS </li></ul><ul><li>Court ordered </li></ul>
  20. 20. Demographics <ul><li>2 million US children and adolescents involved in juvenile justice court system </li></ul><ul><li>50,000-150,000 adolescents in system for treatment and custody </li></ul><ul><li>Disproportionate minority representation </li></ul><ul><li>86-88% male; 12-14 % female </li></ul><ul><li>Age </li></ul><ul><ul><li>4% 12 or younger </li></ul></ul><ul><ul><li>50% age 13-15 </li></ul></ul><ul><ul><li>46% 16 or older </li></ul></ul>
  21. 21. Correlates of adolescent incarceration <ul><li>Diagnoses of learning disability, emotional disturbance, and ADD/ADHD </li></ul><ul><li>Internal locus of control- viewed current incarceration as resulting from personal choice </li></ul><ul><li>63% youth re-offend </li></ul>
  22. 22. What do the three broad out-of-home placement categories have in common? <ul><li>Separation from families and difficulty maintaining parental involvement </li></ul><ul><li>Difficulty supporting successful transition back home </li></ul><ul><li>Poor longitudinal outcomes on multiple construct measures </li></ul>
  23. 23. Outcome measures <ul><li>Disagreement regarding the goal of placement </li></ul><ul><li>Protection </li></ul><ul><li>Permanency </li></ul><ul><li>Symptom extinction or reduction </li></ul><ul><li>Sobriety </li></ul><ul><li>Law abiding behavior </li></ul><ul><li>Other </li></ul><ul><li>How will we measure? </li></ul><ul><li>What else is being left out? </li></ul><ul><li>Are we concerned with efficiency, effectiveness or efficacy? </li></ul>
  24. 24. Omsbudsman’s Appreciative Interview <ul><li>Feeling normal </li></ul><ul><ul><li>Family </li></ul></ul><ul><li>Feeling cared about </li></ul><ul><ul><li>Interest & care </li></ul></ul><ul><ul><li>Supporting family involvement </li></ul></ul><ul><ul><li>Security, structure, & guidance </li></ul></ul><ul><ul><li>Discover & develop potential </li></ul></ul><ul><li>Feeling my opinions matter </li></ul><ul><li>Ideas for Improvement </li></ul><ul><ul><li>Transition </li></ul></ul><ul><ul><li>Communication </li></ul></ul><ul><ul><li>Ordinary activities </li></ul></ul>
  25. 25. <ul><li>Ideas? </li></ul><ul><li>Suggestions? </li></ul>Future Directions Application to Lily <ul><li>Reactions? </li></ul>