Abstract
Children and youth in foster care often have increased medical and behavioral needs, as a result of maltreatment experiences. As primary caregivers, foster parents serve a critical role in ensuring their medical and behavioral health needs are met, yet there is little research depicting foster parents’ experiences with such services. This study examined perspectives of 442 foster parents regarding their experiences with children’s behavioral and medical health services, through closed and open-ended survey questions, to provide further insight into how to best meet the needs of children in the foster care system. Findings suggest that foster parents are generally satisfied with medical services. They were particularly pleased when they perceived caseworkers were efficient with paperwork and provided comprehensive information at intake. They appreciated providers who were able to make appointments on short notice and were patient with children with a variety of needs. Foster parents were less satisfied with behavioral health services. They cited concerns about the timeliness of acquiring behavioral health services, lack of individualized services, and how turnover impacted consistency and progress of services. Consistently, foster parents provided examples of their role in advocating for the needs of the children in their care and described the need to be heard, consulted, and included in assessment and treatment. This study offers important implications for service providers and policy makers to review implementation of current practice and policies, and demonstrates the commitment foster parents have to ensuring the health and behavioral health needs of our most vulnerable children are met.
Similar content being viewed by others
References
Auslander, W. F., McMillen, J., Elze, D., Thompson, R., Jonson-Reid, M., & Stiffman, A. (2002). Mental health problems and sexual abuse among adolescents in foster care: Relationship to HIV risk behaviors and intentions. AIDS and Behavior, 6, 351–359.
Buehler, C., Cox, M. E., & Cuddeback, G. (2003). Foster parents’ perceptions of factors that promote or inhibit successful fostering. Qualitative Social Work, 2(1), 61–83.
Buehler, C., Rhodes, K. W., Orme, J. G., & Cuddeback, G. (2006). The potential for successful family foster care: Conceptualizing competency domains for foster parents. Child Welfare, 85(3), 523–558.
Burns, B. J., Phillips, S. D., Wagner, H. R., Barth, R. P., Kolko, D. J., Campbell, Y., & Landsverk, J. (2004). Mental health need and access to mental health services by youths involved with child welfare: A national survey. Journal of the American Academy of Child and Adolescent Psychiatry, 43(8), 960–970.
Clausen, J. M., Landsverk, J., Ganger, W., Chadwick, D., & Litrownik, A. (1998). Mental health problems of children in foster care. Journal of Child and Family Studies, 7, 283–296.
Creswell, J. W. (2003). Research design: Qualitative, quantitative, and mixed methods approaches (2nd ed.). Thousand Oaks: Sage.
Dos Reis, S., Zito, J. M., Safer, D. J., & Soeken, K. L. (2001). Mental health services for youths in foster care and disabled youths. American Journal of Public Health, 91, 1094–1099.
Garland, A. F., Hough, R. L., Landsverk, J. A., McCabe, K. M., Yeh, M., Ganger, W. C., & Reynolds, B. J. (2000). Racial and ethnic variations in mental health care utilization among children in foster care. Children’s Services: Social policy, Research, & Practice, 3, 133–146.
Geiger, J. M., Hayes, M. J., & Lietz, C. A. (2013). Should I stay or should I go? A mixed methods study examining the factors influencing foster parents' decisions to continue or discontinue providing foster care. Children and Youth Services Review, 35(9), 1356–1365.
Glisson, C. (1994). The effects of services coordination teams on outcomes for children in state custody. Administration in Social Work, 18, 1–23.
Halfon, N., Mendonca, A., & Berkowitz, G. (1995). Health status of children in foster care. The experience of the Center for the Vulnerable Child. Archives of Pediatrics and Adolescent Medicine, 149, 386–392.
Heflinger, C. A., Simpkins, C. G., & Combs-Orme, T. (2000). Using the CBCL to determine the clinical status of children in state custody. Children and Youth Services Review, 22(1), 55–73.
Hudson, P., & Levasseur, K. (2002). Supporting foster parents: Caring voices. Child Welfare, 81(6), 853–877.
Klee, L., Krondstadt, D., & Zlotnick, C. (1997). Foster care’s youngest: A preliminary report. American Journal of Orthopsychiatry, 67, 290–299.
Kortenkamp, K. & Macomber, J.E. (2002). The well-being of children involved with the child welfare system. Washington: Urban Institute. http://www.urban.org/publications/310413.html. Accessed 8 Nov 2014.
Landsverk, J., Burns, B., Stambaugh, L. F., & Rolls-Reutz, J. A. (2006). Mental health care for children and adolescents in foster care: Review of research literature. Seattle: Casey Family Programs.
Landsverk, J., Garland, A. F., & Leslie, L. K. (2002). Mental health services for children reported to child protective services. In J. E. B. Meyers, C. T. Hendrix, L. Berliner, & J. Reid (Eds.), APSAC handbook on child maltreatment (2nd ed.). Thousand Oaks: Sage Publications.
Leslie, L. K., Gordon, J. N., Lambros, K., Premji, K., Peoples, J., & Gist, K. (2005). Addressing the developmental and mental health needs of young children in foster care. Journal of Developmental and Behavioral Pediatrics, 26(2), 140.
Macdonald, G., & Turner, W. (2005). An experiment in helping foster-carers manage challenging behaviour. British Journal of Social Work, 35(8), 1265–1282.
McCrae, J. S. (2009). Emotional and behavioral problems reported in child welfare over 3 years. Journal of Emotional and Behavioral Disorders, 17, 17–28.
McMillen, J. C., Scott, L. D., Zima, B. T., Ollie, M. T., Munson, M. R., & Spitznagel, E. (2004). Use of mental health services among older youths in foster care. Psychiatric Services, 55, 811–817.
McMillen, J. C., Zima, B. T., Scott, L. D, Jr, Auslander, W. F., Munson, M. R., Ollie, M. T., & Spitznagel, E. L. (2005). Prevalence of psychiatric disorders among older youths in the foster care system. Journal of the American Academy of Child and Adolescent Psychiatry, 44(1), 88–95.
Mekonnen, R., Noonan, K., & Rubin, D. (2009). Achieving better health care outcomes for children in foster care. Pediatric Clinics of North America, 56(2), 405–415.
Oswald, S. H., Heil, K., & Goldbeck, L. (2010). History of maltreatment and mental health problems in foster children: A review of the literature. Journal of Pediatric Psychology, 35(5), 462–472.
Pasztor, E. M., Hollinger, D. S., Inkelas, M., & Halfon, N. (2006). Health and mental health services for children in foster care: The central role of foster parents. Child Welfare, 85(1), 33.
Pecora, P. J., Jensen, P. S., Romanelli, L. H., Jackson, L. J., & Ortiz, A. (2009a). Mental health services for children placed in foster care: an overview of current challenges. Child Welfare, 88(1), 5–26.
Pecora, P. J., White, C. R., Jackson, L. J., & Wiggins, T. (2009b). Mental health of current and former recipients of foster care: A review of recent studies in the USA. Child and Family Social Work, 14, 132–146.
Rubin, D., Halfon, N., Raghavan, R., & Rosenbaum, S. (2005). Protecting children in foster care: Why proposed Medicaid cuts harm our nation’s most vulnerable youth. Seattle: Casey Family Programs.
Sawyer, M. G., Carbone, J. A., Searle, A. K., & Robinson, P. (2007). The mental health and well-being of children and adolescents in home-based care. The Medical Journal of Australia, 186(4), 181–184.
Stahmer, A. C., Leslie, L. K., Hurlburt, M., Barth, R. P., Webb, M. B., Landsverk, J., & Zhang, J. (2005). Developmental and behavioral needs and service use for young children in child welfare. Pediatrics, 116, 891–900.
Steele, J. S., & Buchi, K. F. (2008). Medical and mental health of children entering the Utah foster care system. Pediatrics, 122(3), 703–709.
Stroul, B. (2002). Systems of care: A framework for system reform in children’s mental health (Issue brief). Washington: Georgetown University Child Development Center.
Stroul, B. A., & Friedman, R. M. (1996). The system of care concept and philosophy. In B. A. Stroul (Ed.), Children’s mental health: Creating systems of care in a changing society. Paul H. Brookes: Baltimore.
Sullivan, D. J., & van Zyl, M. A. (2008). The well-being of children in foster care: Exploring physical and mental health needs. Children and Youth Services Review, 30(7), 774–786.
Triseliotis, J. P., Borland, M., & Hill, M. (2000). Delivering foster care. London, England: British Agencies for Adoption and Fostering.
Urquiza, A. J., Wirtz, S. J., Peterson, M. S., & Singer, V. A. (1994). Screening and evaluating abused and neglected children entering protective custody. Child Welfare, 123, 155–171.
U.S. Department of Health and Human Services. (2014). The AFCARS report: Preliminary FY 2013 estimates as of July 2014. http://www.acf.hhs.gov/programs/cb/resource/afcars-report-21. Accessed 16 Dec 2014.
Vandivere, S., Chalk, R., & Moore, K.A. (2003). Children in foster homes: How are they faring? Child trends research brief (December 2003). http://www.childtrends.org/files/fosterhomesRB.pdf. Accessed 9 Nov 2014.
Acknowledgments
This research was conducted in collaboration with the statewide public child welfare system and two non-profit organizations that serve foster families. The authors would like to thank Kris Jacober, the Arizona Friends of Foster Children Foundation and the Arizona Association for Foster and Adoptive Parents for their input and collaboration with this project.
Conflict of interest
The authors declare that they have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Hayes, M.J., Geiger, J.M. & Lietz, C.A. Navigating a Complicated System of Care: Foster Parent Satisfaction with Behavioral and Medical Health Services. Child Adolesc Soc Work J 32, 493–505 (2015). https://doi.org/10.1007/s10560-015-0388-2
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10560-015-0388-2